MEDICARE: PROF. EDWARD ALDERETTE 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	101YP2500X	Professional Counselor	9601	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	9601	OTHER	TX	ACP

General Provider Information

NPI Number	:	1225024110
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PROF. EDWARD ALDERETTE LMSW

Provider Business Mailing Address
First Line	:	8245 FREDERICKSBURG RD
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78229-3356
Country	:	US
Telephone Number	:	210-616-0022
Fax Number	:	210-616-0258

Provider Business Practice Location Address
First Line	:	8245 FREDERICKSBURG RD
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78229-3356
Country	:	US
Telephone Number	:	210-616-0022
Fax Number	:	210-616-0258

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

Provider Enumeration Date	:	09/26/2005
Last Update Date	:	07/08/2007

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