MEDICARE: MR. THOMAS JOSEPH PORTNEY M.A.

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	4379	SC

General Provider Information

NPI Number	:	1518914472
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. THOMAS JOSEPH PORTNEY M.A.

Provider Business Mailing Address
First Line	:	1708 BUNTING DR
Second Line	:
City	:	NORTH AUGUSTA
State	:	SC
Zip	:	29841-6124
Country	:	US
Telephone Number	:	803-442-9410
Fax Number	:

Provider Business Practice Location Address
First Line	:	1708 BUNTING DR
Second Line	:
City	:	NORTH AUGUSTA
State	:	SC
Zip	:	29841-6121
Country	:	US
Telephone Number	:	803-442-9410
Fax Number	:

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

Provider Enumeration Date	:	05/27/2006
Last Update Date	:	07/08/2007

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