MEDICARE: MR. PAUL EDWARD LANDMAN 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	15658	CA

General Provider Information

NPI Number	:	1932296118
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. PAUL EDWARD LANDMAN LCSW

Provider Business Mailing Address
First Line	:	300 PRISON RD
Second Line	:	CSP SACRAMENTO - EOP A YARD
City	:	REPRESA
State	:	CA
Zip	:	95671-3001
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	300 PRISON RD
Second Line	:	CSP SACRAMENTO - EOP A YARD
City	:	REPRESA
State	:	CA
Zip	:	95671-3001
Country	:	US
Telephone Number	:	916-985-8610
Fax Number	:

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

Provider Enumeration Date	:	10/06/2006
Last Update Date	:	07/11/2013

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