MEDICARE: MR. ROBERT M. HARDEE LISW

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	6709	SC

General Provider Information

NPI Number	:	1518918531
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. ROBERT M. HARDEE LISW

Provider Business Mailing Address
First Line	:	1530 RICHLAND ST
Second Line	:
City	:	COLUMBIA
State	:	SC
Zip	:	29201-2611
Country	:	US
Telephone Number	:	803-252-4042
Fax Number	:	803-252-7440

Provider Business Practice Location Address
First Line	:	1530 RICHLAND ST
Second Line	:
City	:	COLUMBIA
State	:	SC
Zip	:	29201-2611
Country	:	US
Telephone Number	:	803-252-4042
Fax Number	:	803-252-7440

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

Provider Enumeration Date	:	05/15/2006
Last Update Date	:	07/08/2007

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