MEDICARE: MRS. EMILY N WANG 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	101YM0800X	Mental Health Counselor
2	1041C0700X	Clinical Social Worker	28889	CA

General Provider Information

NPI Number	:	1326138090
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. EMILY N WANG LCSW

Provider Business Mailing Address
First Line	:	1250 MORENA BLVD
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92110-3815
Country	:	US
Telephone Number	:	619-692-8715
Fax Number	:

Provider Business Practice Location Address
First Line	:	1250 MORENA BLVD
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92110-3815
Country	:	US
Telephone Number	:	619-692-8715
Fax Number	:

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

Provider Enumeration Date	:	10/13/2006
Last Update Date	:	07/25/2013

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