MEDICARE: VICTORIA ANDERSON 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	16654	CA

General Provider Information

NPI Number	:	1225686314
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	VICTORIA ANDERSON LCSW

Provider Business Mailing Address
First Line	:	1038 57TH ST
Second Line	:
City	:	OAKLAND
State	:	CA
Zip	:	94608-2706
Country	:	US
Telephone Number	:	510-384-2143
Fax Number	:

Provider Business Practice Location Address
First Line	:	1038 57TH ST
Second Line	:
City	:	OAKLAND
State	:	CA
Zip	:	94608-2706
Country	:	US
Telephone Number	:	510-384-2143
Fax Number	:

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

Provider Enumeration Date	:	08/31/2019
Last Update Date	:	08/31/2019

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