MEDICARE: MR. DANIEL MICHAEL OFFNER 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	LCS 12419	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	228902	OTHER	CA	MHN PROVIDER NUMBER
2	LCS 12419	OTHER	CA	CA LICENSE NUMBER

General Provider Information

NPI Number	:	1235213570
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. DANIEL MICHAEL OFFNER LCSW

Provider Business Mailing Address
First Line	:	333 OLIVE ST
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92103-6215
Country	:	US
Telephone Number	:	619-260-1872
Fax Number	:	619-295-8098

Provider Business Practice Location Address
First Line	:	333 OLIVE ST
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92103-6215
Country	:	US
Telephone Number	:	619-260-1872
Fax Number	:	619-295-8098

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

Provider Enumeration Date	:	10/24/2006
Last Update Date	:	11/22/2010

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