MEDICARE: MRS. JACQUELINE LEVY KUBEL 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	21369	CA

General Provider Information

NPI Number	:	1528097110
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. JACQUELINE LEVY KUBEL LCSW

Provider Business Mailing Address
First Line	:	11080 W OLYMPIC BLVD
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90064-1937
Country	:	US
Telephone Number	:	310-966-6565
Fax Number	:	310-966-9473

Provider Business Practice Location Address
First Line	:	11080 W OLYMPIC BLVD
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90064-1937
Country	:	US
Telephone Number	:	310-966-6565
Fax Number	:	310-966-9473

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

Provider Enumeration Date	:	07/03/2006
Last Update Date	:	09/09/2008

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