MEDICARE: LINDA SUE WELLS 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	12884	CA

General Provider Information

NPI Number	:	1386948826
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LINDA SUE WELLS L.C.S.W.

Provider Business Mailing Address
First Line	:	27 E VICTORIA ST
Second Line	:	SUITE D
City	:	SANTA BARBARA
State	:	CA
Zip	:	93101-2619
Country	:	US
Telephone Number	:	805-965-1651
Fax Number	:	805-845-6738

Provider Business Practice Location Address
First Line	:	27 E VICTORIA ST
Second Line	:	SUITE D
City	:	SANTA BARBARA
State	:	CA
Zip	:	93101-2619
Country	:	US
Telephone Number	:	805-965-1651
Fax Number	:	805-845-6738

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

Provider Enumeration Date	:	12/24/2010
Last Update Date	:	12/24/2010

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