MEDICARE: DR. JULIAN CANO SOCIAL WORKER

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	101YP2500X	Professional Counselor	00433	TX
2	1041C0700X	Clinical Social Worker	4160	TX
3	106H00000X	Marriage & Family Therapist	004122	TX
4	101YA0400X	Addiction (Substance Use Disorder) Counselor	11082	TX

General Provider Information

NPI Number	:	1518939222
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JULIAN CANO SOCIAL WORKER

Provider Business Mailing Address
First Line	:	114 HUNTERS BRANCH ST
Second Line	:
City	:	SHAVANO PARK
State	:	TX
Zip	:	78231-1207
Country	:	US
Telephone Number	:	210-473-8172
Fax Number	:

Provider Business Practice Location Address
First Line	:	114 HUNTERS BRANCH ST
Second Line	:
City	:	SHAVANO PARK
State	:	TX
Zip	:	78231-1207
Country	:	US
Telephone Number	:	210-473-8172
Fax Number	:

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

Provider Enumeration Date	:	02/06/2006
Last Update Date	:	03/05/2012

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