MEDICARE: RENEE D BURWELL LCSW, MPA

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	N/A	CA
2	1041C0700X	Clinical Social Worker	6597	TN

General Provider Information

NPI Number	:	1639337975
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RENEE D BURWELL LCSW, MPA

Provider Business Mailing Address
First Line	:	223 MADISON ST STE 102
Second Line	:
City	:	MADISON
State	:	TN
Zip	:	37115-3660
Country	:	US
Telephone Number	:	615-375-6896
Fax Number	:

Provider Business Practice Location Address
First Line	:	223 MADISON ST STE 102
Second Line	:
City	:	MADISON
State	:	TN
Zip	:	37115-3660
Country	:	US
Telephone Number	:	615-375-6896
Fax Number	:

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

Provider Enumeration Date	:	05/22/2008
Last Update Date	:	11/09/2017

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