MEDICARE: MRS. LEA H BISHOP 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	25219	CA

General Provider Information

NPI Number	:	1437230984
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. LEA H BISHOP LCSW

Provider Business Mailing Address
First Line	:	3611 KEATING ST
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92110-1910
Country	:	US
Telephone Number	:	619-993-4927
Fax Number	:

Provider Business Practice Location Address
First Line	:	7830 CLAIREMONT MESA BLVD
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92111-1619
Country	:	US
Telephone Number	:	619-993-4927
Fax Number	:

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

Provider Enumeration Date	:	10/18/2006
Last Update Date	:	03/12/2010

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