MEDICARE: MS. GILLIAN CAROL FYNN 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	21213	CA

General Provider Information

NPI Number	:	1588615272
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. GILLIAN CAROL FYNN LCSW

Provider Business Mailing Address
First Line	:	2031 6TH ST
Second Line	:	WEST BERKELEY FAMILY PRACTICE
City	:	BERKELEY
State	:	CA
Zip	:	94710-2006
Country	:	US
Telephone Number	:	510-981-4237
Fax Number	:

Provider Business Practice Location Address
First Line	:	2031 6TH ST
Second Line	:	WEST BERKELEY FAMILY PRACTICE
City	:	BERKELEY
State	:	CA
Zip	:	94710-2006
Country	:	US
Telephone Number	:	510-981-4237
Fax Number	:

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

Provider Enumeration Date	:	05/15/2006
Last Update Date	:	07/08/2007

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