MEDICARE: EDITH PARKER

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

General Provider Information

NPI Number	:	1306598479
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EDITH PARKER

Provider Business Mailing Address
First Line	:	5021 LOS MORROS WAY UNIT 36
Second Line	:
City	:	OCEANSIDE
State	:	CA
Zip	:	92057-3732
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	5021 LOS MORROS WAY UNIT 36
Second Line	:
City	:	OCEANSIDE
State	:	CA
Zip	:	92057-3732
Country	:	US
Telephone Number	:	760-617-5296
Fax Number	:

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

Provider Enumeration Date	:	01/20/2022
Last Update Date	:	01/20/2022

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Directions to “ EDITH PARKER ” Practice Location

Language	Start Address	Practice Location

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