MEDICARE: MS. KAREN MALIA LIST 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	26153	CA

General Provider Information

NPI Number	:	1831428564
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. KAREN MALIA LIST LCSW

Provider Business Mailing Address
First Line	:	608 SAN GABRIEL AVE
Second Line	:	APT. C
City	:	ALBANY
State	:	CA
Zip	:	94706-1468
Country	:	US
Telephone Number	:	415-235-6009
Fax Number	:

Provider Business Practice Location Address
First Line	:	608 SAN GABRIEL AVE
Second Line	:	APT. C
City	:	ALBANY
State	:	CA
Zip	:	94706-1468
Country	:	US
Telephone Number	:	415-235-6009
Fax Number	:

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

Provider Enumeration Date	:	12/08/2009
Last Update Date	:	12/08/2009

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