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NPI Code Detail

MEDICARE: MRS. SORREL MADRONA ISHERWOOD LCSW, MPH

MEDICARE: MRS. SORREL MADRONA ISHERWOOD LCSW, MPH
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 Worker21661CA

General Provider Information

NPI Number : 1730365263
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. SORREL MADRONA ISHERWOOD LCSW, MPH
Provider Business Mailing Address
First Line : 1547 PALOS VERDES MALL
Second Line : SUITE 437
City : WALNUT CREEK
State : CA
Zip : 94597-2228
Country : US
Telephone Number : 925-595-4699
Fax Number :
Provider Business Practice Location Address
First Line : 1547 PALOS VERDES MALL
Second Line : SUITE 437
City : WALNUT CREEK
State : CA
Zip : 94597-2228
Country : US
Telephone Number : 925-595-4699
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/15/2008
Last Update Date : 01/15/2008

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