MEDICARE: STEPHAN D ADAMS 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	13030	TX

General Provider Information

NPI Number	:	1851451306
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	STEPHAN D ADAMS LCSW

Provider Business Mailing Address
First Line	:	1110 EIKEL ST STE B
Second Line	:
City	:	NEW BRAUNFELS
State	:	TX
Zip	:	78130-5523
Country	:	US
Telephone Number	:	830-620-4575
Fax Number	:	830-625-8643

Provider Business Practice Location Address
First Line	:	1110 EIKEL ST STE B
Second Line	:
City	:	NEW BRAUNFELS
State	:	TX
Zip	:	78130-5523
Country	:	US
Telephone Number	:	830-620-4575
Fax Number	:	830-625-8643

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

Provider Enumeration Date	:	12/12/2006
Last Update Date	:	07/09/2007

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