MEDICARE: MICHELLE TESORIERO 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	93188	CA

General Provider Information

NPI Number	:	1962005272
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHELLE TESORIERO LCSW

Provider Business Mailing Address
First Line	:	10333 EL CAMINO REAL
Second Line	:
City	:	ATASCADERO
State	:	CA
Zip	:	93422-5808
Country	:	US
Telephone Number	:	805-468-3056
Fax Number	:

Provider Business Practice Location Address
First Line	:	411 JUNIPERO WAY
Second Line	:
City	:	SAN LUIS OBISPO
State	:	CA
Zip	:	93401-6813
Country	:	US
Telephone Number	:	704-619-3688
Fax Number	:

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

Provider Enumeration Date	:	11/18/2020
Last Update Date	:	11/18/2020

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