MEDICARE: MR. MARK ANTHONY ERVI M.S.S.W., 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	01498	TX

General Provider Information

NPI Number	:	1972574077
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. MARK ANTHONY ERVI M.S.S.W., LCSW

Provider Business Mailing Address
First Line	:	608 REGINA DR
Second Line	:
City	:	HEWITT
State	:	TX
Zip	:	76643-3909
Country	:	US
Telephone Number	:	254-666-0590
Fax Number	:

Provider Business Practice Location Address
First Line	:	608 REGINA DR
Second Line	:
City	:	HEWITT
State	:	TX
Zip	:	76643-3909
Country	:	US
Telephone Number	:	254-666-0590
Fax Number	:

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

Provider Enumeration Date	:	01/28/2006
Last Update Date	:	07/08/2007

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