MEDICARE: ROBYN SMITH-BULL 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	104100000X	Social Worker	37902	TX

General Provider Information

NPI Number	:	1275850422
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ROBYN SMITH-BULL LCSW

Provider Business Mailing Address
First Line	:	4917 HARRY HINES BLVD
Second Line	:	DALLAS HEALTHY START
City	:	DALLAS
State	:	TX
Zip	:	75235-7718
Country	:	US
Telephone Number	:	214-590-4967
Fax Number	:	214-590-1672

Provider Business Practice Location Address
First Line	:	4917 HARRY HINES BLVD
Second Line	:	DALLAS HEALTHY START
City	:	DALLAS
State	:	TX
Zip	:	75235-7718
Country	:	US
Telephone Number	:	214-590-4967
Fax Number	:	214-590-1672

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

Provider Enumeration Date	:	04/28/2010
Last Update Date	:	04/28/2010

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