MEDICARE: LINDA R PARK 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	1041C0700X	Clinical Social Worker	LCS2594	CA

General Provider Information

NPI Number	:	1245203538
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LINDA R PARK MSW

Provider Business Mailing Address
First Line	:	1265 CAMINO CORONADO
Second Line	:
City	:	ROHNERT PARK
State	:	CA
Zip	:	94928
Country	:	US
Telephone Number	:	707-795-1590
Fax Number	:	707-792-1600

Provider Business Practice Location Address
First Line	:	2 PADRE PKWY
Second Line	:	STE 100
City	:	ROHNERT PARK
State	:	CA
Zip	:	94928-2114
Country	:	US
Telephone Number	:	707-795-1599
Fax Number	:	707-792-1600

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

Provider Enumeration Date	:	02/08/2006
Last Update Date	:	01/03/2017

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