MEDICARE: MS. AMY ALLISON MAIMAN 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	LCS16768	CA

General Provider Information

NPI Number	:	1679659494
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. AMY ALLISON MAIMAN LCSW

Provider Business Mailing Address
First Line	:	1911 WILLIAMS DR
Second Line	:
City	:	OXNARD
State	:	CA
Zip	:	93036-2612
Country	:	US
Telephone Number	:	805-981-5428
Fax Number	:	805-981-5450

Provider Business Practice Location Address
First Line	:	1911 WILLIAMS DR
Second Line	:
City	:	OXNARD
State	:	CA
Zip	:	93036-2612
Country	:	US
Telephone Number	:	805-981-5428
Fax Number	:	805-981-5450

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

Provider Enumeration Date	:	10/27/2006
Last Update Date	:	06/23/2011

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