MEDICARE: CORNERSTONE CLINICAL ASSESSMENT, INC.

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	251S00000X	Community/Behavioral Health Agency

General Provider Information

NPI Number	:	1215171889
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CORNERSTONE CLINICAL ASSESSMENT, INC.

Provider Business Mailing Address
First Line	:	219 DELTA CT
Second Line	:	UNIT B
City	:	TALLAHASSEE
State	:	FL
Zip	:	32303-4875
Country	:	US
Telephone Number	:	850-445-5533
Fax Number	:

Provider Business Practice Location Address
First Line	:	219 DELTA CT
Second Line	:	UNIT B
City	:	TALLAHASSEE
State	:	FL
Zip	:	32303-4875
Country	:	US
Telephone Number	:	850-445-5533
Fax Number	:

Authorized Official
Title or Position	:	OWNER/THERAPIST
Name	:	MRS. CORENE CREE BAUSERMAN
Credential	:	LCSW
Telephone Number	:	850-445-5533

Provider Enumeration Date	:	04/28/2009
Last Update Date	:	04/28/2009

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