MEDICARE: DONYSIA MARIE GREEN-GILMORE 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	LCS21218	CA

General Provider Information

NPI Number	:	1831298710
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DONYSIA MARIE GREEN-GILMORE LCSW

Provider Business Mailing Address
First Line	:	1021 COSTA PACIFICA WAY
Second Line	:	2107
City	:	OCEANSIDE
State	:	CA
Zip	:	92054-2195
Country	:	US
Telephone Number	:	858-220-9006
Fax Number	:

Provider Business Practice Location Address
First Line	:	1930 S COAST HWY
Second Line	:	SUITE 202
City	:	OCEANSIDE
State	:	CA
Zip	:	92054-6455
Country	:	US
Telephone Number	:	858-220-9006
Fax Number	:

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

Provider Enumeration Date	:	09/21/2006
Last Update Date	:	10/19/2010

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