=====================================================
General NPI Number Information
=====================================================
NPI Number | 1336605963
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ELIZABETH WALKER ROBINSON LICSW
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/19/2019
-----------------------------------------------------
Last Update Date | 05/07/2019
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 7085 SYDNEY CURV
-----------------------------------------------------
City | MONTGOMERY
-----------------------------------------------------
State | AL
-----------------------------------------------------
Zip | 36117-3509
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 334-270-5502
-----------------------------------------------------
Fax | 334-270-5503
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 7085 SYDNEY CURV
-----------------------------------------------------
City | MONTGOMERY
-----------------------------------------------------
State | AL
-----------------------------------------------------
Zip | 36117-3509
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 334-270-5502
-----------------------------------------------------
Fax | 334-270-5503
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number | 4166C
-----------------------------------------------------
License Number State | AL
-----------------------------------------------------