MEDICARE: MS. LYNN DORA WALDMAN 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	LCS16999	CA

General Provider Information

NPI Number	:	1306164645
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. LYNN DORA WALDMAN LCSW

Provider Business Mailing Address
First Line	:	1325 PACIFIC HWY
Second Line	:	SUITE 605
City	:	SAN DIEGO
State	:	CA
Zip	:	92101-2580
Country	:	US
Telephone Number	:	619-865-3203
Fax Number	:	619-294-9424

Provider Business Practice Location Address
First Line	:	3435 CAMINO DEL RIO SOUTH
Second Line	:	SUITE 217
City	:	SAN DIEGO
State	:	CA
Zip	:	92108-3902
Country	:	US
Telephone Number	:	619-865-3203
Fax Number	:	619-294-9424

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

Provider Enumeration Date	:	05/11/2010
Last Update Date	:	08/02/2011

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