MEDICARE: MS. WENDY ANDERSON RAB LCSW, MFCC

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	101YM0800X	Mental Health Counselor	LCS 16810	CA
2	101YM0800X	Mental Health Counselor	MFC30090	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	54220ZZZ54134Z	OTHER	CA	BLUE SHIELD

General Provider Information

NPI Number	:	1811007719
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. WENDY ANDERSON RAB LCSW, MFCC

Provider Business Mailing Address
First Line	:	9264 MADISON AVE
Second Line	:	ROLLINGWOOD OFFICE PARK
City	:	ORANGEVALE
State	:	CA
Zip	:	95662-5858
Country	:	US
Telephone Number	:	916-988-2824
Fax Number	:	916-988-2824

Provider Business Practice Location Address
First Line	:	9264 MADISON AVE
Second Line	:	ROLLINGWOOD OFFICE PARK
City	:	ORANGEVALE
State	:	CA
Zip	:	95662-5858
Country	:	US
Telephone Number	:	916-988-2824
Fax Number	:	916-988-2824

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

Provider Enumeration Date	:	08/30/2006
Last Update Date	:	09/15/2009

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