MEDICARE: VIOLA E VERA LICENSED SOCIAL WORK

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	251B00000X	Case Management Agency
2	171M00000X	Case Manager/Care Coordinator	27841	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	146555103	OTHER	TX	CASE MANAGEMENT

General Provider Information

NPI Number	:	1316034382
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	VIOLA E VERA LICENSED SOCIAL WORK

Provider Business Mailing Address
First Line	:	1236 ROCKY RD
Second Line	:
City	:	UHLAND
State	:	TX
Zip	:	78640-6522
Country	:	US
Telephone Number	:	512-679-3438
Fax Number	:	512-632-7200

Provider Business Practice Location Address
First Line	:	1236 ROCKY RD
Second Line	:
City	:	UHLAND
State	:	TX
Zip	:	78640-6522
Country	:	US
Telephone Number	:	512-679-3438
Fax Number	:	512-632-7200

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

Provider Enumeration Date	:	10/09/2006
Last Update Date	:	05/02/2023

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