MEDICARE: KATHLEEN ELLIOTT-MCCREA RN, 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	104100000X	Social Worker	23710	CA

General Provider Information

NPI Number	:	1992929681
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KATHLEEN ELLIOTT-MCCREA RN, LCSW

Provider Business Mailing Address
First Line	:	195 A HARVEY WEST BLVD.
Second Line	:
City	:	SANTA CRUZ
State	:	CA
Zip	:	95060
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	191 HARVEY WEST BLVD
Second Line	:
City	:	SANTA CRUZ
State	:	CA
Zip	:	95060-2126
Country	:	US
Telephone Number	:	831-469-1700
Fax Number	:

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

Provider Enumeration Date	:	04/12/2007
Last Update Date	:	02/10/2009

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