=====================================================
General NPI Number Information
=====================================================
NPI Number | 1679904940
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MARGOT MYERS M.S.W., LCSW, BCD
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/11/2013
-----------------------------------------------------
Last Update Date | 01/10/2014
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 160 THIRD STREET
-----------------------------------------------------
City | BEAVER
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 15009
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 724-775-2032
-----------------------------------------------------
Fax | 724-775-2750
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 1301
-----------------------------------------------------
City | ALIQUIPPA
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 15001-6301
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 814-598-5935
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
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 | CW014260
-----------------------------------------------------
License Number State | PA
-----------------------------------------------------