MEDICARE: MRS. GENOVEVA CALLOWAY 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	LCS10386	CA

General Provider Information

NPI Number	:	1790845469
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. GENOVEVA CALLOWAY LCSW

Provider Business Mailing Address
First Line	:	1529 COSTA AVE
Second Line	:
City	:	SAN PABLO
State	:	CA
Zip	:	94806-4719
Country	:	US
Telephone Number	:	510-374-3490
Fax Number	:	510-374-7274

Provider Business Practice Location Address
First Line	:	256 24TH ST
Second Line	:
City	:	RICHMOND
State	:	CA
Zip	:	94804-1804
Country	:	US
Telephone Number	:	510-374-3467
Fax Number	:

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

Provider Enumeration Date	:	12/11/2006
Last Update Date	:	07/08/2007

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