MEDICARE: MS. IRENE G. NATHANSON 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	34004542A	IN
2	1041C0700X	Clinical Social Worker	149-006655	IL

General Provider Information

NPI Number	:	1659352573
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. IRENE G. NATHANSON LCSW

Provider Business Mailing Address
First Line	:	20372 N 110TH LN
Second Line	:
City	:	SUN CITY
State	:	AZ
Zip	:	85373-2304
Country	:	US
Telephone Number	:	623-225-7365
Fax Number	:

Provider Business Practice Location Address
First Line	:	20372 N 110TH LN
Second Line	:
City	:	SUN CITY
State	:	AZ
Zip	:	85373-2304
Country	:	US
Telephone Number	:	623-225-7365
Fax Number	:

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

Provider Enumeration Date	:	11/08/2005
Last Update Date	:	11/05/2011

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