MEDICARE: MRS. PATRICIA KIM WHITSON 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	104100000X	Social Worker	LCS11479	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	SW11479B	OTHER		MEDICAL

General Provider Information

NPI Number	:	1538231899
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. PATRICIA KIM WHITSON LCSW

Provider Business Mailing Address
First Line	:	5360 JACKSON DR
Second Line	:	SUITE 119
City	:	LA MESA
State	:	CA
Zip	:	91942-6002
Country	:	US
Telephone Number	:	619-303-8078
Fax Number	:	619-303-8078

Provider Business Practice Location Address
First Line	:	5360 JACKSON DR
Second Line	:	SUITE 119
City	:	LA MESA
State	:	CA
Zip	:	91942-6002
Country	:	US
Telephone Number	:	619-303-8078
Fax Number	:	619-303-8078

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

Provider Enumeration Date	:	11/14/2006
Last Update Date	:	08/18/2008

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Directions to “ MRS. PATRICIA KIM WHITSON LCSW” Practice Location

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