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NPI Code Detail

MEDICARE: ROBERT H LEYENDECKER III LMSW-ACP

MEDICARE: ROBERT H LEYENDECKER III LMSW-ACP
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 Worker24033TX

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
10098KMOTHERTXBCBS

General Provider Information

NPI Number : 1134176712
Entity Type Code : Individual
Provider Name (Legal Business Name) : ROBERT H LEYENDECKER III LMSW-ACP
Provider Business Mailing Address
First Line : 819 1/2 W 11TH STREET
Second Line :
City : AUSTIN
State : TX
Zip : 78701-2009
Country : US
Telephone Number : 512-619-8611
Fax Number :
Provider Business Practice Location Address
First Line : 819 W 11TH ST
Second Line :
City : AUSTIN
State : TX
Zip : 78701-2009
Country : US
Telephone Number : 512-619-8611
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/28/2006
Last Update Date : 07/08/2007

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