MEDICARE: SUSAN BROOKE GARNER MFT

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	174400000X	Specialist	MFC 33442	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	17440000X	OTHER	CA	SOLE PROPRIETOR

General Provider Information

NPI Number	:	1487819108
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SUSAN BROOKE GARNER MFT

Provider Business Mailing Address
First Line	:	5610 SNAKE RD
Second Line	:
City	:	OAKLAND
State	:	CA
Zip	:	94611-2910
Country	:	US
Telephone Number	:	510-466-5669
Fax Number	:

Provider Business Practice Location Address
First Line	:	5610 SNAKE RD
Second Line	:
City	:	OAKLAND
State	:	CA
Zip	:	94611-2910
Country	:	US
Telephone Number	:	510-466-5669
Fax Number	:

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

Provider Enumeration Date	:	07/22/2008
Last Update Date	:	11/25/2008

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