MEDICARE: SARA TRAVER BSW

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	104100000X	Social Worker

General Provider Information

NPI Number	:	1184715054
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SARA TRAVER BSW

Provider Business Mailing Address
First Line	:	4665 51ST ST
Second Line	:	APT. 2
City	:	SAN DIEGO
State	:	CA
Zip	:	92115-3406
Country	:	US
Telephone Number	:	619-582-2457
Fax Number	:

Provider Business Practice Location Address
First Line	:	2840 ADAMS AVE
Second Line	:	STE. 103
City	:	SAN DIEGO
State	:	CA
Zip	:	92116-1403
Country	:	US
Telephone Number	:	619-283-5731
Fax Number	:	619-283-1877

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

Provider Enumeration Date	:	09/27/2006
Last Update Date	:	07/08/2007

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