MEDICARE: MRS. STACEY HILTS ROSAS 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	51816	TX

General Provider Information

NPI Number	:	1275824591
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. STACEY HILTS ROSAS LCSW

Provider Business Mailing Address
First Line	:	5224 MOON SHADOW DR
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78735-6015
Country	:	US
Telephone Number	:	512-587-1107
Fax Number	:	866-587-1655

Provider Business Practice Location Address
First Line	:	5224 MOON SHADOW DR
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78735-6015
Country	:	US
Telephone Number	:	512-587-1107
Fax Number	:	866-587-1655

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

Provider Enumeration Date	:	04/20/2011
Last Update Date	:	05/10/2023

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