MEDICARE: DANIEL ROGER EBERHARDT 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	LCS19058	CA

General Provider Information

NPI Number	:	1730273988
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DANIEL ROGER EBERHARDT LCSW

Provider Business Mailing Address
First Line	:	22 CANTATA DR
Second Line	:
City	:	MISSION VIEJO
State	:	CA
Zip	:	92692-5102
Country	:	US
Telephone Number	:	949-874-5960
Fax Number	:

Provider Business Practice Location Address
First Line	:	1651 E 4TH ST
Second Line	:	SUITE 128
City	:	SANTA ANA
State	:	CA
Zip	:	92701-5164
Country	:	US
Telephone Number	:	949-874-5960
Fax Number	:	714-972-3744

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

Provider Enumeration Date	:	10/03/2006
Last Update Date	:	04/23/2008

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