MEDICARE: BRIAN DUNN 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	53417	TX

General Provider Information

NPI Number	:	1750723813
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRIAN DUNN LCSW

Provider Business Mailing Address
First Line	:	145 MEADOWS DR N
Second Line	:
City	:	GRANBURY
State	:	TX
Zip	:	76048-1870
Country	:	US
Telephone Number	:	847-987-6102
Fax Number	:

Provider Business Practice Location Address
First Line	:	145 MEADOWS DR N
Second Line	:
City	:	GRANBURY
State	:	TX
Zip	:	76048-1870
Country	:	US
Telephone Number	:	847-987-6102
Fax Number	:

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

Provider Enumeration Date	:	07/17/2013
Last Update Date	:	07/17/2013

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