MEDICARE: MS. NANCY R BOX 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	12733	TX

General Provider Information

NPI Number	:	1396788899
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. NANCY R BOX LCSW

Provider Business Mailing Address
First Line	:	1937 CHATBURN CT
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76110-1210
Country	:	US
Telephone Number	:	817-602-0554
Fax Number	:	775-459-0849

Provider Business Practice Location Address
First Line	:	4255 BRYANT IRVIN RD
Second Line	:	SUITE 107
City	:	FORT WORTH
State	:	TX
Zip	:	76109-4233
Country	:	US
Telephone Number	:	817-602-0554
Fax Number	:	775-459-0849

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

Provider Enumeration Date	:	06/13/2006
Last Update Date	:	07/08/2007

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