MEDICARE: VANESSA ALMODOVAR 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	59457	TX

General Provider Information

NPI Number	:	1255810487
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	VANESSA ALMODOVAR LCSW

Provider Business Mailing Address
First Line	:	3840 HULEN ST
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76107-7277
Country	:	US
Telephone Number	:	817-569-4300
Fax Number	:

Provider Business Practice Location Address
First Line	:	4600 GREENVILLE AVE STE 252
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75206-5037
Country	:	US
Telephone Number	:	844-824-8775
Fax Number	:	281-648-2200

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

Provider Enumeration Date	:	08/08/2018
Last Update Date	:	02/01/2024

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