MEDICARE: AMY RUTH PARKS LCSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	22207	CA
2	1041C0700X	Clinical Social Worker	LCSW22207	CA

General Provider Information

NPI Number	:	1174747984
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AMY RUTH PARKS LCSW

Provider Business Mailing Address
First Line	:	7545 N DEL MAR AVE STE 105
Second Line	:
City	:	FRESNO
State	:	CA
Zip	:	93711-6872
Country	:	US
Telephone Number	:	559-224-2469
Fax Number	:	559-224-2469

Provider Business Practice Location Address
First Line	:	7545 N DEL MAR AVE STE 105
Second Line	:
City	:	FRESNO
State	:	CA
Zip	:	93711-6872
Country	:	US
Telephone Number	:	559-224-2469
Fax Number	:	559-224-2469

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/12/2007
Last Update Date	:	12/18/2024

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Directions to “ AMY RUTH PARKS LCSW” Practice Location

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