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NPI Code Detail

MEDICARE: MS. ELIZABETH JAYNE MCPHERSON LCSW

MEDICARE: MS. ELIZABETH JAYNE MCPHERSON 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
11041C0700XClinical Social Worker34002969IN

General Provider Information

NPI Number : 1467655969
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. ELIZABETH JAYNE MCPHERSON LCSW
Provider Business Mailing Address
First Line : 616 E COLFAX AVE
Second Line :
City : SOUTH BEND
State : IN
Zip : 46617-2827
Country : US
Telephone Number : 574-289-7000
Fax Number :
Provider Business Practice Location Address
First Line : 616 E COLFAX AVE
Second Line :
City : SOUTH BEND
State : IN
Zip : 46617-2827
Country : US
Telephone Number : 574-289-7000
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/11/2007
Last Update Date : 07/08/2007

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