MEDICARE: MR. MARK GROBLEWSKI 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	32398	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	00000082JZ	OTHER	TX	BLUECROSS BLUESHIELD
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1790864221
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. MARK GROBLEWSKI LCSW

Provider Business Mailing Address
First Line	:	1110 NASA PKWY
Second Line	:	STE 545K
City	:	HOUSTON
State	:	TX
Zip	:	77058-3358
Country	:	US
Telephone Number	:	281-482-5999
Fax Number	:	281-993-2354

Provider Business Practice Location Address
First Line	:	1110 NASA PKWY
Second Line	:	STE 545K
City	:	HOUSTON
State	:	TX
Zip	:	77058-3358
Country	:	US
Telephone Number	:	832-687-7915
Fax Number	:

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

Provider Enumeration Date	:	11/03/2006
Last Update Date	:	08/19/2016

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