MEDICARE: MRS. MARY A KERR L.C.S.W.

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	28650	CA

General Provider Information

NPI Number	:	1952646887
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. MARY A KERR L.C.S.W.

Provider Business Mailing Address
First Line	:	26751 VISTA DEL MAR
Second Line	:
City	:	DANA POINT
State	:	CA
Zip	:	92624-1512
Country	:	US
Telephone Number	:	714-913-3129
Fax Number	:

Provider Business Practice Location Address
First Line	:	16152 BEACH BLVD STE 200
Second Line	:
City	:	HUNTINGTON BEACH
State	:	CA
Zip	:	92647-3869
Country	:	US
Telephone Number	:	714-913-3129
Fax Number	:

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

Provider Enumeration Date	:	12/04/2012
Last Update Date	:	06/17/2015

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