Healthcare Provider Details

I. General information

NPI: 1114746807
Provider Name (Legal Business Name): EMILY OBRONT LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/09/2024
Last Update Date: 10/09/2024
Certification Date: 09/17/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4022 MENCHACA RD
AUSTIN TX
78704-6746
US

IV. Provider business mailing address

4022 MENCHACA RD
AUSTIN TX
78704-6746
US

V. Phone/Fax

Practice location:
  • Phone: 512-982-4116
  • Fax:
Mailing address:
  • Phone: 512-982-4116
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number66064
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: