MEDICARE: MRS. PATRICIA A BARTHOLOW 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	LCS1181	CA

General Provider Information

NPI Number	:	1730207507
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. PATRICIA A BARTHOLOW LCSW

Provider Business Mailing Address
First Line	:	7777 ALVARADO RD # 278
Second Line	:
City	:	LA MESA
State	:	CA
Zip	:	91941-3616
Country	:	US
Telephone Number	:	619-994-7852
Fax Number	:	619-265-1802

Provider Business Practice Location Address
First Line	:	7777 ALVARADO RD # 278
Second Line	:
City	:	LA MESA
State	:	CA
Zip	:	91941-3616
Country	:	US
Telephone Number	:	619-994-7852
Fax Number	:	619-265-1802

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

Provider Enumeration Date	:	03/27/2007
Last Update Date	:	07/08/2007

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