MEDICARE: ELAINE ADOLF BARRON 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	LCS 12174	CA

General Provider Information

NPI Number	:	1366572836
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ELAINE ADOLF BARRON LCSW

Provider Business Mailing Address
First Line	:	950 N RAMONA BLVD
Second Line	:	STE. 2
City	:	SAN JACINTO
State	:	CA
Zip	:	92582-2567
Country	:	US
Telephone Number	:	951-487-2674
Fax Number	:	951-487-2679

Provider Business Practice Location Address
First Line	:	950 N RAMONA BLVD
Second Line	:	STE. 2
City	:	SAN JACINTO
State	:	CA
Zip	:	92582-2567
Country	:	US
Telephone Number	:	951-487-2674
Fax Number	:	951-487-2679

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

Provider Enumeration Date	:	03/06/2007
Last Update Date	:	12/09/2010

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