MEDICARE: MR. ROBERT WARD DAVIS 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	LCS12618	CA

General Provider Information

NPI Number	:	1336257898
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. ROBERT WARD DAVIS LCSW

Provider Business Mailing Address
First Line	:	1650 MISSION ST
Second Line	:
City	:	SAN FRANCISCO
State	:	CA
Zip	:	94103-2414
Country	:	US
Telephone Number	:	415-355-3570
Fax Number	:	415-350-6750

Provider Business Practice Location Address
First Line	:	1650 MISSION ST
Second Line	:
City	:	SAN FRANCISCO
State	:	CA
Zip	:	94103-2414
Country	:	US
Telephone Number	:	415-355-3570
Fax Number	:	415-355-6750

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

Provider Enumeration Date	:	08/26/2006
Last Update Date	:	07/10/2012

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