MEDICARE: MS. SHARON MARIE LEWIS-CHACON LISW

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	I-3060	NM
2	1041C0700X	Clinical Social Worker	12687	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1003965179
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. SHARON MARIE LEWIS-CHACON LISW

Provider Business Mailing Address
First Line	:	7208 PICKARD AVE NE
Second Line	:
City	:	ALBUQUERQUE
State	:	NM
Zip	:	87110-1412
Country	:	US
Telephone Number	:	505-550-4016
Fax Number	:	505-865-3268

Provider Business Practice Location Address
First Line	:	6633 E HIGHWAY 290
Second Line	:	SUITE 303
City	:	AUSTIN
State	:	TX
Zip	:	78723-1172
Country	:	US
Telephone Number	:	512-637-2040
Fax Number	:	512-637-2044

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

Provider Enumeration Date	:	01/09/2007
Last Update Date	:	02/16/2009

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Directions to “ MS. SHARON MARIE LEWIS-CHACON LISW” Practice Location

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