MEDICARE: NICOLE DUARTE GALVAN 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	104187	TX
2	104100000X	Social Worker	104187	TX

General Provider Information

NPI Number	:	1194505990
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NICOLE DUARTE GALVAN LCSW

Provider Business Mailing Address
First Line	:	48 N HUTCHESON ST
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77003-1848
Country	:	US
Telephone Number	:	409-939-1842
Fax Number	:

Provider Business Practice Location Address
First Line	:	400 HARBORSIDE DR
Second Line	:	STE 118-119
City	:	GALVESTON
State	:	TX
Zip	:	77555-0001
Country	:	US
Telephone Number	:	409-772-0770
Fax Number	:

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

Provider Enumeration Date	:	09/29/2023
Last Update Date	:	02/12/2026

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