MEDICARE: MS. EMILY CAROLINE WOODY 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	68189	TX

General Provider Information

NPI Number	:	1043052830
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. EMILY CAROLINE WOODY LCSW

Provider Business Mailing Address
First Line	:	4707 SURRATT RD
Second Line	:
City	:	LONGVIEW
State	:	TX
Zip	:	75604-9484
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3316 GUADALUPE ST APT 307
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78705-2335
Country	:	US
Telephone Number	:	903-738-9523
Fax Number	:

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

Provider Enumeration Date	:	06/11/2024
Last Update Date	:	06/11/2024

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