MEDICARE: NEAL BENNER MCSHERRY M.A.

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	103TC2200X	Clinical Child & Adolescent Psychologist

General Provider Information

NPI Number	:	1508955436
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NEAL BENNER MCSHERRY M.A.

Provider Business Mailing Address
First Line	:	1470 CALIFORNIA ST APT 2
Second Line	:
City	:	SAN FRANCISCO
State	:	CA
Zip	:	94109-4701
Country	:	US
Telephone Number	:	510-332-4232
Fax Number	:

Provider Business Practice Location Address
First Line	:	161 MITCHELL BLVD STE 101
Second Line	:
City	:	SAN RAFAEL
State	:	CA
Zip	:	94903-2068
Country	:	US
Telephone Number	:	415-499-7594
Fax Number	:

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

Provider Enumeration Date	:	10/11/2006
Last Update Date	:	07/08/2007

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