MEDICARE: CARA ELIZABETH FAIRFAX 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	18858	CA

General Provider Information

NPI Number	:	1952422008
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CARA ELIZABETH FAIRFAX LCSW

Provider Business Mailing Address
First Line	:	11025 FUERTE DR
Second Line	:
City	:	LA MESA
State	:	CA
Zip	:	91941-7161
Country	:	US
Telephone Number	:	619-219-4313
Fax Number	:

Provider Business Practice Location Address
First Line	:	7339 EL CAJON BLVD
Second Line	:	SUITE K
City	:	SAN DIEGO
State	:	CA
Zip	:	91941
Country	:	US
Telephone Number	:	619-668-6200
Fax Number	:

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

Provider Enumeration Date	:	04/03/2007
Last Update Date	:	08/23/2016

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