MEDICARE: DAISY TOVAR NIETO 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	52834	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	52834	OTHER	TX	LCSW LICENSE ISSUED BY TEXAS STATE BOARD OF SOCIAL WORK EXAMINERS

General Provider Information

NPI Number	:	1487899415
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DAISY TOVAR NIETO LCSW

Provider Business Mailing Address
First Line	:	94 BRIGGS ST STE 700
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78224-1272
Country	:	US
Telephone Number	:	210-924-3556
Fax Number	:	210-924-3557

Provider Business Practice Location Address
First Line	:	94 BRIGGS ST STE 700
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78224-1272
Country	:	US
Telephone Number	:	210-924-3556
Fax Number	:	210-924-3557

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

Provider Enumeration Date	:	12/04/2008
Last Update Date	:	03/17/2018

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