MEDICARE: GWYNETH RENEE HOBSON LCSW, BCD

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	114982	TX
2	1041C0700X	Clinical Social Worker	C006210	NC

General Provider Information

NPI Number	:	1487688040
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GWYNETH RENEE HOBSON LCSW, BCD

Provider Business Mailing Address
First Line	:	3630 STANLEY RD BLDG 2841
Second Line	:
City	:	JBSA FT SAM HOUSTON
State	:	TX
Zip	:	78234-7697
Country	:	US
Telephone Number	:	520-716-5250
Fax Number	:

Provider Business Practice Location Address
First Line	:	3630 STANLEY RD
Second Line	:
City	:	JBSA FT SAM HOUSTON
State	:	TX
Zip	:	78234-7697
Country	:	US
Telephone Number	:	520-716-5250
Fax Number	:

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

Provider Enumeration Date	:	07/10/2006
Last Update Date	:	12/10/2025

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