MEDICARE: VICTORIA MINCHILLO-KINYON L.C.S.W. AND L.E.P.

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	103TS0200X	School Psychologist	LEP2752	CO
2	1041C0700X	Clinical Social Worker	LCSW 21156	CA

General Provider Information

NPI Number	:	1902275985
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	VICTORIA MINCHILLO-KINYON L.C.S.W. AND L.E.P.

Provider Business Mailing Address
First Line	:	3000 PARKER RD # 20
Second Line	:
City	:	RICHMOND
State	:	CA
Zip	:	94806-2742
Country	:	US
Telephone Number	:	510-816-6014
Fax Number	:

Provider Business Practice Location Address
First Line	:	3000 PARKER RD # 20
Second Line	:
City	:	RICHMOND
State	:	CA
Zip	:	94806-2742
Country	:	US
Telephone Number	:	510-307-4643
Fax Number	:

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

Provider Enumeration Date	:	09/18/2015
Last Update Date	:	06/07/2021

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