MEDICARE: KAIRN MARY GEBAUER MSW

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	LCS24341	CA

General Provider Information

NPI Number	:	1205966769
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KAIRN MARY GEBAUER MSW

Provider Business Mailing Address
First Line	:	3301 E 12TH ST
Second Line	:	SUITE 259
City	:	OAKLAND
State	:	CA
Zip	:	94601-3424
Country	:	US
Telephone Number	:	510-269-9030
Fax Number	:	510-265-8212

Provider Business Practice Location Address
First Line	:	3301 E 12TH ST
Second Line	:	SUITE 259
City	:	OAKLAND
State	:	CA
Zip	:	94601-3424
Country	:	US
Telephone Number	:	510-269-9030
Fax Number	:	510-265-8212

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

Provider Enumeration Date	:	03/06/2007
Last Update Date	:	06/18/2012

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