MEDICARE: MR. BRIAN ANTHONY MCDONALD 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	LCS16344	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	LCS16344	OTHER	CA	LICENSE

General Provider Information

NPI Number	:	1801934732
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. BRIAN ANTHONY MCDONALD LCSW

Provider Business Mailing Address
First Line	:	4242 STANSBURY AVE UNIT 106
Second Line	:
City	:	SHERMAN OAKS
State	:	CA
Zip	:	91423-4249
Country	:	US
Telephone Number	:	818-624-7175
Fax Number	:

Provider Business Practice Location Address
First Line	:	4242 STANSBURY AVE UNIT 106
Second Line	:
City	:	SHERMAN OAKS
State	:	CA
Zip	:	91423-4249
Country	:	US
Telephone Number	:	818-624-7175
Fax Number	:

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

Provider Enumeration Date	:	02/02/2007
Last Update Date	:	07/08/2007

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