MEDICARE: JONATHAN HERALD LMSW

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	25445	MD

General Provider Information

NPI Number	:	1154031235
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JONATHAN HERALD LMSW

Provider Business Mailing Address
First Line	:	4025 DUVAL RD APT 2424
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78759-3435
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4025 DUVAL RD APT 2424
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78759-3435
Country	:	US
Telephone Number	:	240-938-1406
Fax Number	:

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

Provider Enumeration Date	:	11/30/2022
Last Update Date	:	11/30/2022

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