MEDICARE: MRS. LILLIAN JANINE GOLDFARB 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	LCS17720	CA

General Provider Information

NPI Number	:	1902820905
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. LILLIAN JANINE GOLDFARB LCSW

Provider Business Mailing Address
First Line	:	3916 CALLE VALLE VIS
Second Line	:
City	:	NEWBURY PARK
State	:	CA
Zip	:	91320-1938
Country	:	US
Telephone Number	:	805-490-0455
Fax Number	:	805-499-2433

Provider Business Practice Location Address
First Line	:	30101 AGOURA CT STE 240
Second Line	:
City	:	AGOURA HILLS
State	:	CA
Zip	:	91301-5901
Country	:	US
Telephone Number	:	805-490-0455
Fax Number	:	805-499-2433

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

Provider Enumeration Date	:	07/26/2006
Last Update Date	:	07/08/2007

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