MEDICARE: ELIZABETH FLEMING HUMMERT 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	104100000X	Social Worker	40267	TX

General Provider Information

NPI Number	:	1558576611
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ELIZABETH FLEMING HUMMERT LCSW

Provider Business Mailing Address
First Line	:	2209 HOMECRAFT LN
Second Line	:
City	:	BEDFORD
State	:	TX
Zip	:	76021-3667
Country	:	US
Telephone Number	:	817-223-9734
Fax Number	:

Provider Business Practice Location Address
First Line	:	1723 HEMPHILL ST
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76110-1516
Country	:	US
Telephone Number	:	817-927-4039
Fax Number	:

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

Provider Enumeration Date	:	05/11/2007
Last Update Date	:	07/08/2007

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