MEDICARE: BEVERLY KAGAN

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	LCS27655	CA

General Provider Information

NPI Number	:	1699845982
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BEVERLY KAGAN

Provider Business Mailing Address
First Line	:	7828 HAVEN AVE
Second Line	:
City	:	RANCHO CUCAMONGA
State	:	CA
Zip	:	91730-3049
Country	:	US
Telephone Number	:	909-451-9185
Fax Number	:	909-912-8027

Provider Business Practice Location Address
First Line	:	7828 HAVEN AVE
Second Line	:
City	:	RANCHO CUCAMONGA
State	:	CA
Zip	:	91730-3049
Country	:	US
Telephone Number	:	909-451-9185
Fax Number	:	909-912-8027

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

Provider Enumeration Date	:	11/08/2006
Last Update Date	:	03/11/2022

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Directions to “ BEVERLY KAGAN ” Practice Location

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