MEDICARE: ERIN M PRETZER 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	34006032A	IN

General Provider Information

NPI Number	:	1376856781
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ERIN M PRETZER LCSW

Provider Business Mailing Address
First Line	:	310 N MICHIGAN ST STE 204
Second Line	:	C/O CARRIE CADWELL - CREDENTIALING
City	:	PLYMOUTH
State	:	IN
Zip	:	46563-1774
Country	:	US
Telephone Number	:	574-936-3031
Fax Number	:	866-311-5621

Provider Business Practice Location Address
First Line	:	310 N MICHIGAN ST STE 204
Second Line	:	C/O CARRIE CADWELL - CREDENTIALING
City	:	PLYMOUTH
State	:	IN
Zip	:	46563-1774
Country	:	US
Telephone Number	:	574-936-3031
Fax Number	:	866-311-5621

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

Provider Enumeration Date	:	07/15/2010
Last Update Date	:	05/15/2013

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