MEDICARE: ANGELA Y MA 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	101YM0800X	Mental Health Counselor	LCS 12366	CA

General Provider Information

NPI Number	:	1467464487
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANGELA Y MA LCSW

Provider Business Mailing Address
First Line	:	4141 GEARY BLVD FL 3
Second Line	:
City	:	SAN FRANCISCO
State	:	CA
Zip	:	94118-3111
Country	:	US
Telephone Number	:	415-308-0037
Fax Number	:

Provider Business Practice Location Address
First Line	:	1730 DIVISADERO ST
Second Line	:
City	:	SAN FRANCISCO
State	:	CA
Zip	:	94115-3012
Country	:	US
Telephone Number	:	415-308-0037
Fax Number	:

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

Provider Enumeration Date	:	08/12/2006
Last Update Date	:	07/08/2007

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