MEDICARE: MS. GRACE MARIE STUART 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	S00573	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier Issuer
1	10011672	OTHER	AMERIGROUP
2	275652000	OTHER	MAGELLAN
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1578571535
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. GRACE MARIE STUART LCSW

Provider Business Mailing Address
First Line	:	PO BOX 7312
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77248-7312
Country	:	US
Telephone Number	:	832-622-5518
Fax Number	:	713-473-0070

Provider Business Practice Location Address
First Line	:	3522 SUNSET BLVD
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77005-2134
Country	:	US
Telephone Number	:	832-622-5518
Fax Number	:	713-473-0070

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

Provider Enumeration Date	:	08/04/2006
Last Update Date	:	08/03/2009

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