MEDICARE: MISS BECKY R POPOWSKI 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	26294	CA

General Provider Information

NPI Number	:	1861739906
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MISS BECKY R POPOWSKI LCSW

Provider Business Mailing Address
First Line	:	6610 EMBARCADERO DR APT 7
Second Line	:
City	:	STOCKTON
State	:	CA
Zip	:	95219-3348
Country	:	US
Telephone Number	:	209-323-4332
Fax Number	:

Provider Business Practice Location Address
First Line	:	2529 W MARCH LN
Second Line	:	SUITE 203
City	:	STOCKTON
State	:	CA
Zip	:	95207-8270
Country	:	US
Telephone Number	:	209-403-9669
Fax Number	:

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

Provider Enumeration Date	:	01/09/2013
Last Update Date	:	01/09/2013

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