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NPI Code Detail

MEDICARE: MR. PAUL BERDOFE LCSW

MEDICARE: MR. PAUL BERDOFE 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
11041C0700XClinical Social Worker00122TX

General Provider Information

NPI Number : 1922059989
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. PAUL BERDOFE LCSW
Provider Business Mailing Address
First Line : 271 MANCHESTER LN
Second Line :
City : AUSTIN
State : TX
Zip : 78737-4540
Country : US
Telephone Number : 512-891-9171
Fax Number : 512-389-6545
Provider Business Practice Location Address
First Line : 2901 MONTOPOLIS DR
Second Line :
City : AUSTIN
State : TX
Zip : 78741-6411
Country : US
Telephone Number : 512-389-6527
Fax Number : 512-389-6545
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/15/2006
Last Update Date : 07/08/2007

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