MEDICARE: CARMEL MARY O'REARDON 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	34140	TX

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
5	TXB122976	OTHER	TX	MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	01411352	OTHER	TX	AMERIGROUP
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1114196698
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CARMEL MARY O'REARDON LCSW

Provider Business Mailing Address
First Line	:	2828 BAMMEL LN APT 810
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77098-1146
Country	:	US
Telephone Number	:	832-721-7470
Fax Number	:

Provider Business Practice Location Address
First Line	:	2828 BAMMEL LN APT 810
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77098-1146
Country	:	US
Telephone Number	:	832-721-7470
Fax Number	:

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

Provider Enumeration Date	:	02/28/2008
Last Update Date	:	03/05/2021

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