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NPI Code Detail

MEDICARE: JOAN DEREBERY LANDGUTH LCSW

MEDICARE: JOAN DEREBERY LANDGUTH 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
11041C0700XClinical Social WorkerLCS9104CA

General Provider Information

NPI Number : 1336224302
Entity Type Code : Individual
Provider Name (Legal Business Name) : JOAN DEREBERY LANDGUTH LCSW
Provider Business Mailing Address
First Line : 5568 LINDA ROSA AVE
Second Line :
City : LA JOLLA
State : CA
Zip : 92037-7630
Country : US
Telephone Number : 858-361-9366
Fax Number :
Provider Business Practice Location Address
First Line : 140 ARBOR DR
Second Line :
City : SAN DIEGO
State : CA
Zip : 92103-2007
Country : US
Telephone Number : 858-361-9366
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/26/2006
Last Update Date : 07/08/2007

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