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General NPI Number Information
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NPI Number | 1083662381
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Entity Type | Individual
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Provider Name | SUE GENARO LEGACY LCSW
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Gender | Female
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Dates
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Enumeration Date | 05/05/2006
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Last Update Date | 06/28/2017
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Provider Practice Location Address
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Address Line | 12741 N HWY 183 SUITE 300
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City | AUSTIN
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State | TX
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Zip | 78759-4388
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Country | US
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Telephone | 512-331-6005
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Fax | 512-331-0505
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Provider Business Mailing Address
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Address Line | 308 MEADOW LN
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City | DENTON
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State | TX
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Zip | 76207-7412
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Country | US
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Telephone | 512-496-6700
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Fax | 512-496-6700
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | S26921
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License Number State | TX
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