Individual
BEVERLY ANN KOERNER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LCS
Contact information
Practice address
1400 EMELINE AVENUE, SANTA CRUZ, CA 95060-1976
(831) 454-4170
Mailing address
1400 EMELINE AVENUE, SANTA CRUZ, CA 95060-1976
(831) 454-4170
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
LCS21464
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
LCS 21464
CALIFORNIA
CA
01
—
ZZZ92069Z
MEDICARE GROUP ID#
CA
Enumeration date
05/08/2007
Last updated
08/30/2013
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