MEDICARE: ALEXANDRA MCCLUNG 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	70678	CA
2	101YM0800X	Mental Health Counselor
3	104100000X	Social Worker	31135	CA

General Provider Information

NPI Number	:	1700195062
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALEXANDRA MCCLUNG LCSW

Provider Business Mailing Address
First Line	:	13924 MARQUESAS WAY
Second Line	:	#1525
City	:	MARINA DEL REY
State	:	CA
Zip	:	90292-6041
Country	:	US
Telephone Number	:	310-463-6436
Fax Number	:

Provider Business Practice Location Address
First Line	:	3838 S CENTINELA AVE
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90066-4402
Country	:	US
Telephone Number	:	310-463-6436
Fax Number	:

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

Provider Enumeration Date	:	10/04/2010
Last Update Date	:	05/27/2016

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