MEDICARE: KATE VIERNES, LICENSED CLINICAL SOCIAL WORKER, PC

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

General Provider Information

NPI Number	:	1780457820
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KATE VIERNES, LICENSED CLINICAL SOCIAL WORKER, PC

Provider Business Mailing Address
First Line	:	3253 RAMA DR UNIT 2
Second Line	:
City	:	SAN JOSE
State	:	CA
Zip	:	95124-2352
Country	:	US
Telephone Number	:	415-236-3965
Fax Number	:

Provider Business Practice Location Address
First Line	:	3253 RAMA DR UNIT 2
Second Line	:
City	:	SAN JOSE
State	:	CA
Zip	:	95124-2352
Country	:	US
Telephone Number	:	415-236-3965
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	KATE VIERNES
Credential	:	LCSW
Telephone Number	:	415-236-3965

Provider Enumeration Date	:	10/31/2023
Last Update Date	:	10/31/2023

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