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NPI Code Detail

MEDICARE: MS. CHERYL NANETTE MIMS LCSW

MEDICARE: MS. CHERYL NANETTE MIMS 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
11041C0700XClinical Social Worker21288CA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
121288OTHERCALICENSE NUMBER

General Provider Information

NPI Number : 1710918677
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. CHERYL NANETTE MIMS LCSW
Provider Business Mailing Address
First Line : 1887 MONTEREY HWY STE 200
Second Line :
City : SAN JOSE
State : CA
Zip : 95112-6192
Country : US
Telephone Number : 408-790-7864
Fax Number :
Provider Business Practice Location Address
First Line : 1887 MONTEREY HWY STE 200
Second Line :
City : SAN JOSE
State : CA
Zip : 95112-6192
Country : US
Telephone Number : 408-790-7864
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/06/2006
Last Update Date : 05/19/2021

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Directions to “ MS. CHERYL NANETTE MIMS LCSW” Practice Location

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