MEDICARE: ELEANOR V DWYER 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	LCS14761	CA

General Provider Information

NPI Number	:	1861523011
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ELEANOR V DWYER LCSW

Provider Business Mailing Address
First Line	:	1838 EL CAMINO REAL STE 230
Second Line	:
City	:	BURLINGAME
State	:	CA
Zip	:	94010-3112
Country	:	US
Telephone Number	:	650-689-5461
Fax Number	:

Provider Business Practice Location Address
First Line	:	1838 EL CAMINO REAL STE 230
Second Line	:
City	:	BURLINGAME
State	:	CA
Zip	:	94010-3112
Country	:	US
Telephone Number	:	650-689-5461
Fax Number	:

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

Provider Enumeration Date	:	03/08/2007
Last Update Date	:	02/22/2019

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Directions to “ ELEANOR V DWYER LCSW” Practice Location

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