MEDICARE: MARCHETTA A. RAMIREZ LMSW-ACP

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	11592	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	00S33N	OTHER	TX	BLUECROSSBLUESHIELD PROVI

General Provider Information

NPI Number	:	1467675140
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARCHETTA A. RAMIREZ LMSW-ACP

Provider Business Mailing Address
First Line	:	707 W 10TH ST
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78701-2033
Country	:	US
Telephone Number	:	512-322-0006
Fax Number	:

Provider Business Practice Location Address
First Line	:	707 W 10TH ST
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78701-2033
Country	:	US
Telephone Number	:	512-322-0006
Fax Number	:

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

Provider Enumeration Date	:	04/11/2007
Last Update Date	:	07/08/2007

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