MEDICARE: SHERYL STEPHANIE WAMSLEY-GOLDSMITH 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	LCS20718	CA

General Provider Information

NPI Number	:	1285961748
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHERYL STEPHANIE WAMSLEY-GOLDSMITH LCSW

Provider Business Mailing Address
First Line	:	5581 SPA DR
Second Line	:
City	:	HUNTINGTON BEACH
State	:	CA
Zip	:	92647-2022
Country	:	US
Telephone Number	:	714-898-8656
Fax Number	:

Provider Business Practice Location Address
First Line	:	408 WESTMINSTER AVE
Second Line	:	SUITE 10
City	:	NEWPORT BEACH
State	:	CA
Zip	:	92663-4238
Country	:	US
Telephone Number	:	949-244-2982
Fax Number	:

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

Provider Enumeration Date	:	11/04/2009
Last Update Date	:	11/04/2009

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