MEDICARE: SUSAN EMERY L.C.S.W.

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	22893	TX

General Provider Information

NPI Number	:	1376773259
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SUSAN EMERY L.C.S.W.

Provider Business Mailing Address
First Line	:	1907 SANTA CLARA ST
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78757-2424
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1907 SANTA CLARA ST
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78757-2424
Country	:	US
Telephone Number	:	512-626-2365
Fax Number	:

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

Provider Enumeration Date	:	07/25/2009
Last Update Date	:	07/25/2009

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