MEDICARE: MS. TERU JUDY KANAZAWA 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	27683	CA

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	11298014100812-001	OTHER	CA	MEDICARE, ALLIED HEALTH

General Provider Information

NPI Number	:	1710010483
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. TERU JUDY KANAZAWA LCSW

Provider Business Mailing Address
First Line	:	1323 EAST WINDSOR RD
Second Line	:
City	:	GLENDALE
State	:	CA
Zip	:	91205-2662
Country	:	US
Telephone Number	:	310-579-2047
Fax Number	:

Provider Business Practice Location Address
First Line	:	1323 EAST WINDSOR RD
Second Line	:
City	:	GLENDALE
State	:	CA
Zip	:	91205-2662
Country	:	US
Telephone Number	:	310-579-2047
Fax Number	:

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

Provider Enumeration Date	:	03/13/2007
Last Update Date	:	03/10/2016

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