MEDICARE: MS. MARSHA KAZUKO SHINOZAKI MSW, 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	28172	CA

General Provider Information

NPI Number	:	1295844173
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. MARSHA KAZUKO SHINOZAKI MSW, LCSW

Provider Business Mailing Address
First Line	:	5080 E PELTIER RD
Second Line	:
City	:	ACAMPO
State	:	CA
Zip	:	95220-9633
Country	:	US
Telephone Number	:	916-412-5726
Fax Number	:

Provider Business Practice Location Address
First Line	:	8788 ELK GROVE BLVD
Second Line	:
City	:	ELK GROVE
State	:	CA
Zip	:	95624-1766
Country	:	US
Telephone Number	:	916-714-6060
Fax Number	:	916-714-6067

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

Provider Enumeration Date	:	08/30/2006
Last Update Date	:	02/29/2012

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