MEDICARE: MS. KATHRYN BLISS DAVIS 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	LCS22878	CA

General Provider Information

NPI Number	:	1487751145
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. KATHRYN BLISS DAVIS LCSW

Provider Business Mailing Address
First Line	:	755 S VAN NESS AVE
Second Line	:
City	:	SAN FRANCISCO
State	:	CA
Zip	:	94110-1908
Country	:	US
Telephone Number	:	415-642-4580
Fax Number	:	415-695-6961

Provider Business Practice Location Address
First Line	:	1380 HOWARD ST
Second Line	:	5TH FLOOR
City	:	SAN FRANCISCO
State	:	CA
Zip	:	94103-2638
Country	:	US
Telephone Number	:	415-255-3699
Fax Number	:	415-252-3015

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

Provider Enumeration Date	:	09/17/2006
Last Update Date	:	12/14/2009

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