MEDICARE: SUSAN PATRICIA MUNSEY L.C.S.W.

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	LCS20428	CA

General Provider Information

NPI Number	:	1356312383
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SUSAN PATRICIA MUNSEY L.C.S.W.

Provider Business Mailing Address
First Line	:	4061 INGALLS ST
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92103-1732
Country	:	US
Telephone Number	:	619-818-4026
Fax Number	:	619-229-2333

Provider Business Practice Location Address
First Line	:	6475 ALVARADO RD
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92120-5013
Country	:	US
Telephone Number	:	858-279-1223
Fax Number	:	619-229-2333

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

Provider Enumeration Date	:	01/28/2006
Last Update Date	:	07/08/2007

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