MEDICARE: KENDRA MCGIVNEY 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	390200000X	Student in an Organized Health Care Education/Training Program
2	1041C0700X	Clinical Social Worker	29852	CA

General Provider Information

NPI Number	:	1932335510
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KENDRA MCGIVNEY LCSW

Provider Business Mailing Address
First Line	:	240 E 20TH ST
Second Line	:
City	:	LONG BEACH
State	:	CA
Zip	:	90806-5418
Country	:	US
Telephone Number	:	562-599-9271
Fax Number	:	562-218-6578

Provider Business Practice Location Address
First Line	:	3605 LONG BEACH BLVD STE 331
Second Line	:
City	:	LONG BEACH
State	:	CA
Zip	:	90807-4025
Country	:	US
Telephone Number	:	562-989-0537
Fax Number	:	562-989-0573

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

Provider Enumeration Date	:	06/09/2009
Last Update Date	:	12/03/2015

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