MEDICARE: KATHLEEN L MCGILL 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	24046	CA

General Provider Information

NPI Number	:	1669672077
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KATHLEEN L MCGILL LCSW

Provider Business Mailing Address
First Line	:	2344 6TH ST
Second Line	:
City	:	BERKELEY
State	:	CA
Zip	:	94710-2412
Country	:	US
Telephone Number	:	510-684-6940
Fax Number	:

Provider Business Practice Location Address
First Line	:	9925 INTERNATIONAL BLVD STE 6
Second Line	:
City	:	OAKLAND
State	:	CA
Zip	:	94603-2558
Country	:	US
Telephone Number	:	510-562-3731
Fax Number	:

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

Provider Enumeration Date	:	07/23/2007
Last Update Date	:	07/01/2014

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