MEDICARE: KAITLIN MIKA MASATSUGU 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	81092	CA

General Provider Information

NPI Number	:	1790445781
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KAITLIN MIKA MASATSUGU LCSW

Provider Business Mailing Address
First Line	:	2150 N 1ST ST STE 650
Second Line	:
City	:	SAN JOSE
State	:	CA
Zip	:	95131-2031
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2150 N 1ST ST STE 650
Second Line	:
City	:	SAN JOSE
State	:	CA
Zip	:	95131-2031
Country	:	US
Telephone Number	:	408-436-3300
Fax Number	:

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

Provider Enumeration Date	:	12/18/2021
Last Update Date	:	10/10/2024

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