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NPI Code Detail

MEDICARE: MICHAEL G ANDERSON MSW, LICSW

MEDICARE:   MICHAEL G ANDERSON  MSW, LICSW
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 WorkerBP00944286WV
21041C0700XClinical Social WorkerDP00944286WV

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1DP00944286OTHERWVCLINICAL LICENSE

General Provider Information

NPI Number : 1215362256
Entity Type Code : Individual
Provider Name (Legal Business Name) : MICHAEL G ANDERSON MSW, LICSW
Provider Business Mailing Address
First Line : 115 SUMMERS HOSPITAL RD
Second Line :
City : HINTON
State : WV
Zip : 25951-5172
Country : US
Telephone Number : 304-466-2918
Fax Number :
Provider Business Practice Location Address
First Line : 115 SUMMERS HOSPITAL RD
Second Line :
City : HINTON
State : WV
Zip : 25951-5172
Country : US
Telephone Number : 304-466-1000
Fax Number : 304-466-2942
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/10/2013
Last Update Date : 09/19/2018

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Directions to “ MICHAEL G ANDERSON MSW, LICSW” Practice Location

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