MEDICARE: MS. CAROL ANN KELLY DILWORTH L.B.S.W

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	25770	TX
2	171M00000X	Case Manager/Care Coordinator	25770	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	25770	OTHER	TX	TEXAS STATE BOARD OF SOCI

General Provider Information

NPI Number	:	1720288806
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. CAROL ANN KELLY DILWORTH L.B.S.W

Provider Business Mailing Address
First Line	:	7555 FOSS MDWS
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78244-2250
Country	:	US
Telephone Number	:	210-875-4663
Fax Number	:	--

Provider Business Practice Location Address
First Line	:	7555 FOSS MDWS
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78244-2250
Country	:	US
Telephone Number	:	210-875-4663
Fax Number	:	--

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

Provider Enumeration Date	:	07/18/2007
Last Update Date	:	12/06/2007

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