MEDICARE: MRS. DOROTHY DEVEREUX

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	101Y00000X	Counselor

General Provider Information

NPI Number	:	1528188679
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. DOROTHY DEVEREUX

Provider Business Mailing Address
First Line	:	7985 VINTAGE WAY
Second Line	:
City	:	FAIR OAKS
State	:	CA
Zip	:	95628-3665
Country	:	US
Telephone Number	:	916-364-8488
Fax Number	:	916-364-8486

Provider Business Practice Location Address
First Line	:	3050 FITE CIR
Second Line	:	112
City	:	SACRAMENTO
State	:	CA
Zip	:	95827-1806
Country	:	US
Telephone Number	:	916-364-8488
Fax Number	:	916-364-8486

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

Provider Enumeration Date	:	03/30/2007
Last Update Date	:	07/08/2007

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