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NPI Code Detail

MEDICARE: MS. KATY BRODERICK MCELROY L.C.S.W.

MEDICARE: MS. KATY BRODERICK MCELROY L.C.S.W.
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
11041C0700XClinical Social Worker00761TX

General Provider Information

NPI Number : 1053472720
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. KATY BRODERICK MCELROY L.C.S.W.
Provider Business Mailing Address
First Line : 1430 COLLIER ST
Second Line :
City : AUSTIN
State : TX
Zip : 78704-2911
Country : US
Telephone Number : 512-445-7787
Fax Number : 512-440-4059
Provider Business Practice Location Address
First Line : 1717 W 10TH ST
Second Line :
City : AUSTIN
State : TX
Zip : 78703-3907
Country : US
Telephone Number : 512-804-3162
Fax Number : 512-472-4008
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/13/2006
Last Update Date : 07/08/2007

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