MEDICARE: ROBERT G. CHILDERS 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	LCS14719	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1130	OTHER		CBHS INTERNAL USE ONLY-COMMERCIAL NUMBER
2	1130	OTHER		SFGH INTERNAL USE ONLY

General Provider Information

NPI Number	:	1992828412
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ROBERT G. CHILDERS LCSW

Provider Business Mailing Address
First Line	:	298 MONTEREY BLVD
Second Line	:
City	:	SAN FRANCISCO
State	:	CA
Zip	:	94131-3140
Country	:	US
Telephone Number	:	415-337-4795
Fax Number	:	415-337-4816

Provider Business Practice Location Address
First Line	:	298 MONTEREY BLVD
Second Line	:
City	:	SAN FRANCISCO
State	:	CA
Zip	:	94131-3140
Country	:	US
Telephone Number	:	415-337-4795
Fax Number	:	415-337-4816

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

Provider Enumeration Date	:	04/09/2007
Last Update Date	:	07/16/2007

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