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NPI Code Detail

MEDICARE: JEFFREY LEE SOMERSETT LCSW

MEDICARE: JEFFREY LEE SOMERSETT 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
1101YM0800XMental Health Counselor18843CA

General Provider Information

NPI Number : 1205530789
Entity Type Code : Individual
Provider Name (Legal Business Name) : JEFFREY LEE SOMERSETT LCSW
Provider Business Mailing Address
First Line : 2152 ALAMEDA AVE
Second Line :
City : ALAMEDA
State : CA
Zip : 94501-4308
Country : US
Telephone Number : 510-495-4948
Fax Number :
Provider Business Practice Location Address
First Line : 18949 REDWOOD RD
Second Line :
City : CASTRO VALLEY
State : CA
Zip : 94546-3153
Country : US
Telephone Number : 510-495-4948
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/28/2023
Last Update Date : 03/28/2023

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