MEDICARE: MS. GEORGETTE L COBBS A.A., B.A., M.S.

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	106H00000X	Marriage & Family Therapist	IMF53125	CA

General Provider Information

NPI Number	:	1831396233
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. GEORGETTE L COBBS A.A., B.A., M.S.

Provider Business Mailing Address
First Line	:	1841 BERKELEY WAY
Second Line	:
City	:	BERKELEY
State	:	CA
Zip	:	94703-1576
Country	:	US
Telephone Number	:	510-558-1990
Fax Number	:	510-559-3558

Provider Business Practice Location Address
First Line	:	1841 BERKELEY WAY
Second Line	:
City	:	BERKELEY
State	:	CA
Zip	:	94703-1576
Country	:	US
Telephone Number	:	510-558-1990
Fax Number	:	510-559-3558

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

Provider Enumeration Date	:	06/28/2007
Last Update Date	:	07/08/2007

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