MEDICARE: MR. ROBERT LEE COE 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	101YM0800X	Mental Health Counselor	LCS 15838	CA

General Provider Information

NPI Number	:	1902908643
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. ROBERT LEE COE LCSW

Provider Business Mailing Address
First Line	:	3527 SACRAMENTO ST STE 102
Second Line	:
City	:	SAN FRANCISCO
State	:	CA
Zip	:	94118-1884
Country	:	US
Telephone Number	:	415-563-3294
Fax Number	:	510-531-4764

Provider Business Practice Location Address
First Line	:	3527 SACRAMENTO ST STE 102
Second Line	:
City	:	SAN FRANCISCO
State	:	CA
Zip	:	94118-1884
Country	:	US
Telephone Number	:	415-563-3294
Fax Number	:	510-531-4764

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

Provider Enumeration Date	:	09/02/2006
Last Update Date	:	07/08/2007

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