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NPI Code Detail

MEDICARE: COLLEEN AUTH LCSW

MEDICARE: COLLEEN AUTH 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
11041C0700XClinical Social WorkerLCS20994CA

General Provider Information

NPI Number : 1598022907
Entity Type Code : Individual
Provider Name (Legal Business Name) : COLLEEN AUTH LCSW
Provider Business Mailing Address
First Line : 3411 3RD AVE
Second Line :
City : SAN DIEGO
State : CA
Zip : 92103-4906
Country : US
Telephone Number : 619-818-2256
Fax Number : 858-373-2148
Provider Business Practice Location Address
First Line : 3411 3RD AVE
Second Line :
City : SAN DIEGO
State : CA
Zip : 92103-4906
Country : US
Telephone Number : 619-818-2256
Fax Number : 858-373-2148
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/23/2012
Last Update Date : 07/24/2019

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Directions to “ COLLEEN AUTH LCSW” Practice Location

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