MEDICARE: DEBORAH D VINES 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	LSW0000004074	TN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	265374000	OTHER	TN	MAGELLAN PROVIDER NUMBER
2	457801	OTHER	TN	VALUE OPTIONS PROVIDER #
3	7239269	OTHER	TN	AETNA PROVIDER NUMBER
4	2072152	OTHER	TN	CIGNA PROVIDER NUMBER
5	4080157	OTHER	TN	BCBS PROVIDER NUMBER

General Provider Information

NPI Number	:	1134273360
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DEBORAH D VINES LCSW

Provider Business Mailing Address
First Line	:	1900 CHURCH ST STE 300
Second Line	:
City	:	NASHVILLE
State	:	TN
Zip	:	37203-2285
Country	:	US
Telephone Number	:	727-313-1426
Fax Number	:	615-983-6975

Provider Business Practice Location Address
First Line	:	2320 W END AVE
Second Line	:
City	:	NASHVILLE
State	:	TN
Zip	:	37203-1784
Country	:	US
Telephone Number	:	727-313-1426
Fax Number	:	615-983-6975

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

Provider Enumeration Date	:	01/23/2007
Last Update Date	:	06/16/2018

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