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NPI Code Detail

MEDICARE: VANESSSA IRENE EGERTON LCSW

MEDICARE:   VANESSSA IRENE EGERTON  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
11041S0200XSchool Social WorkerTX
21041C0700XClinical Social Worker57546TX

General Provider Information

NPI Number : 1669002937
Entity Type Code : Individual
Provider Name (Legal Business Name) : VANESSSA IRENE EGERTON LCSW
Provider Business Mailing Address
First Line : 17618 BENT CYPRESS DR
Second Line :
City : SPRING
State : TX
Zip : 77388-5708
Country : US
Telephone Number : 713-397-5047
Fax Number :
Provider Business Practice Location Address
First Line : 17618 BENT CYPRESS DR
Second Line :
City : SPRING
State : TX
Zip : 77388-5708
Country : US
Telephone Number : 713-397-5047
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/24/2020
Last Update Date : 01/27/2020

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Directions to “ VANESSSA IRENE EGERTON LCSW” Practice Location

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