MEDICARE: RACHEL AMBER BRODY 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	20195	CA

General Provider Information

NPI Number	:	1619106705
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RACHEL AMBER BRODY LCSW

Provider Business Mailing Address
First Line	:	445 CHURCH ST.
Second Line	:
City	:	SAN FRANCISCO
State	:	CA
Zip	:	94114
Country	:	US
Telephone Number	:	415-729-3871
Fax Number	:

Provider Business Practice Location Address
First Line	:	2722 GOUPH STREET
Second Line	:
City	:	SAN FRANCISCO
State	:	CA
Zip	:	94123-4405
Country	:	US
Telephone Number	:	415-729-3871
Fax Number	:

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

Provider Enumeration Date	:	07/09/2009
Last Update Date	:	01/08/2013

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