MEDICARE: MRS. JEAN B TAYLOR 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	LCS 006425	CA

General Provider Information

NPI Number	:	1669460523
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. JEAN B TAYLOR LCSW

Provider Business Mailing Address
First Line	:	450 DONDEE ST
Second Line	:	SUITE #9
City	:	PACIFICA
State	:	CA
Zip	:	94044-3056
Country	:	US
Telephone Number	:	650-738-9550
Fax Number	:	650-738-9567

Provider Business Practice Location Address
First Line	:	450 DONDEE ST
Second Line	:	SUITE #9
City	:	PACIFICA
State	:	CA
Zip	:	94044-3056
Country	:	US
Telephone Number	:	650-738-9550
Fax Number	:	650-738-9567

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

Provider Enumeration Date	:	10/13/2005
Last Update Date	:	07/08/2007

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