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NPI Code Detail

MEDICARE: MS. LAUREN RAE LIBERTY LCSW

MEDICARE: MS. LAUREN RAE LIBERTY 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 WorkerLCS 22803CA

General Provider Information

NPI Number : 1609092212
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. LAUREN RAE LIBERTY LCSW
Provider Business Mailing Address
First Line : PO BOX 2121
Second Line :
City : SAN ANDREAS
State : CA
Zip : 95249-2121
Country : US
Telephone Number : 209-304-3986
Fax Number :
Provider Business Practice Location Address
First Line : 10400 FRICOT CITY RD
Second Line :
City : SAN ANDREAS
State : CA
Zip : 95249-9642
Country : US
Telephone Number : 209-304-3986
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/18/2007
Last Update Date : 11/08/2011

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