MEDICARE: M. KATHLEEN MCBRIDE MSW

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	LW00005285	WA
2	1041C0700X	Clinical Social Worker	LCSW-11854	AZ

General Provider Information

NPI Number	:	1407848369
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	M. KATHLEEN MCBRIDE MSW

Provider Business Mailing Address
First Line	:	2548 N SUNSET RD
Second Line	:
City	:	APACHE JUNCTION
State	:	AZ
Zip	:	85219-8985
Country	:	US
Telephone Number	:	480-338-4095
Fax Number	:	480-219-9977

Provider Business Practice Location Address
First Line	:	2730 S VAL VISTA DR
Second Line	:	SUITE 135
City	:	GILBERT
State	:	AZ
Zip	:	85295-1675
Country	:	US
Telephone Number	:	480-338-4095
Fax Number	:

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

Provider Enumeration Date	:	08/17/2005
Last Update Date	:	01/09/2009

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