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NPI Code Detail

MEDICARE: JUDITH DIETZ LURIE L.C.S.W.

MEDICARE: JUDITH DIETZ LURIE L.C.S.W.
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
11041C0700XClinical Social WorkerLCS6152CA

General Provider Information

NPI Number : 1578798476
Entity Type Code : Individual
Provider Name (Legal Business Name) : JUDITH DIETZ LURIE L.C.S.W.
Provider Business Mailing Address
First Line : 210 N 4TH ST STE 100
Second Line :
City : SAN JOSE
State : CA
Zip : 95112-5573
Country : US
Telephone Number : 408-295-5288
Fax Number :
Provider Business Practice Location Address
First Line : 210 N 4TH ST STE 100
Second Line :
City : SAN JOSE
State : CA
Zip : 95112-5573
Country : US
Telephone Number : 408-295-5288
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/20/2009
Last Update Date : 05/20/2009

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Directions to “ JUDITH DIETZ LURIE L.C.S.W.” Practice Location

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