MEDICARE: JOEL ALAN STEPHEN 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	112292	TX

General Provider Information

NPI Number	:	1093550253
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOEL ALAN STEPHEN LCSW

Provider Business Mailing Address
First Line	:	7017 AVIGNON DR
Second Line	:
City	:	ROUND ROCK
State	:	TX
Zip	:	78681-5331
Country	:	US
Telephone Number	:	737-333-1656
Fax Number	:

Provider Business Practice Location Address
First Line	:	7017 AVIGNON DR
Second Line	:
City	:	ROUND ROCK
State	:	TX
Zip	:	78681-5331
Country	:	US
Telephone Number	:	737-333-1656
Fax Number	:

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

Provider Enumeration Date	:	06/28/2024
Last Update Date	:	04/06/2026

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