MEDICARE: MS. LARKIN MARIE BOERO

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	101Y00000X	Counselor

General Provider Information

NPI Number	:	1609902527
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. LARKIN MARIE BOERO

Provider Business Mailing Address
First Line	:	1138 FRANCISCO ST
Second Line	:
City	:	BERKELEY
State	:	CA
Zip	:	94702-1333
Country	:	US
Telephone Number	:	925-212-2510
Fax Number	:

Provider Business Practice Location Address
First Line	:	2462 DOLAN WAY
Second Line	:
City	:	SAN PABLO
State	:	CA
Zip	:	94806
Country	:	US
Telephone Number	:	510-741-2824
Fax Number	:

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

Provider Enumeration Date	:	02/26/2007
Last Update Date	:	07/08/2007

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