MEDICARE: EDWARD ALLEN BRUSHER 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	2364	GA

General Provider Information

NPI Number	:	1982751822
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EDWARD ALLEN BRUSHER LCSW

Provider Business Mailing Address
First Line	:	145 PHANTOM CRK
Second Line	:
City	:	CIBOLO
State	:	TX
Zip	:	78108-4277
Country	:	US
Telephone Number	:	210-375-4869
Fax Number	:	210-221-7235

Provider Business Practice Location Address
First Line	:	USA MEDCOM
Second Line	:	2050 WORTH ROAD, SUITE 10
City	:	FORT SAM HOUSTON
State	:	TX
Zip	:	78234-6010
Country	:	US
Telephone Number	:	210-221-8235
Fax Number	:	210-221-7235

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

Provider Enumeration Date	:	01/04/2007
Last Update Date	:	07/08/2007

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Directions to “ EDWARD ALLEN BRUSHER LCSW” Practice Location

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