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NPI Code Detail

MEDICARE: GLEN CALVERT LCSW

MEDICARE:   GLEN  CALVERT  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
11041C0700XClinical Social Worker50335TX

General Provider Information

NPI Number : 1245670884
Entity Type Code : Individual
Provider Name (Legal Business Name) : GLEN CALVERT LCSW
Provider Business Mailing Address
First Line : 6243 W INTERSTATE 10
Second Line : STE 1050
City : SAN ANTONIO
State : TX
Zip : 78201-2086
Country : US
Telephone Number : 210-293-0883
Fax Number : 210-293-0885
Provider Business Practice Location Address
First Line : 6243 W INTERSTATE 10
Second Line : STE 1050
City : SAN ANTONIO
State : TX
Zip : 78201-2086
Country : US
Telephone Number : 210-293-0883
Fax Number : 210-293-0885
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/27/2013
Last Update Date : 06/27/2013

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Directions to “ GLEN CALVERT LCSW” Practice Location

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