MEDICARE: BERREVONNE DAOODI ACSW

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	133438	CA

General Provider Information

NPI Number	:	1548945652
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BERREVONNE DAOODI ACSW

Provider Business Mailing Address
First Line	:	7227 BROADWAY STE 403
Second Line	:
City	:	LEMON GROVE
State	:	CA
Zip	:	91945-1505
Country	:	US
Telephone Number	:	619-771-2181
Fax Number	:

Provider Business Practice Location Address
First Line	:	7227 BROADWAY STE 403
Second Line	:
City	:	LEMON GROVE
State	:	CA
Zip	:	91945-1505
Country	:	US
Telephone Number	:	619-771-2181
Fax Number	:

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

Provider Enumeration Date	:	06/16/2023
Last Update Date	:	06/07/2026

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