MEDICARE: WILLIAM JOSEPH DRISCOLL 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	1189-123	WI
2	1041C0700X	Clinical Social Worker	L4579	OR

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	:	1396822995
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	WILLIAM JOSEPH DRISCOLL LCSW

Provider Business Mailing Address
First Line	:	36 SW NYE ST
Second Line	:
City	:	NEWPORT
State	:	OR
Zip	:	97365-3821
Country	:	US
Telephone Number	:	541-265-0513
Fax Number	:	541-867-6548

Provider Business Practice Location Address
First Line	:	4909 S COAST HWY
Second Line	:
City	:	SOUTH BEACH
State	:	OR
Zip	:	97366-9616
Country	:	US
Telephone Number	:	541-574-5960
Fax Number	:	541-867-6548

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

Provider Enumeration Date	:	11/01/2006
Last Update Date	:	06/14/2010

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