MEDICARE: CHRISANDRA L KOVAREK LCSW-S

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	38700	TX

General Provider Information

NPI Number	:	1528694510
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHRISANDRA L KOVAREK LCSW-S

Provider Business Mailing Address
First Line	:	301 BELLE LN
Second Line	:
City	:	PORT LAVACA
State	:	TX
Zip	:	77979-2014
Country	:	US
Telephone Number	:	361-676-3620
Fax Number	:

Provider Business Practice Location Address
First Line	:	301 BELLE LN
Second Line	:
City	:	PORT LAVACA
State	:	TX
Zip	:	77979-2014
Country	:	US
Telephone Number	:	361-676-3620
Fax Number	:

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

Provider Enumeration Date	:	03/21/2020
Last Update Date	:	09/11/2024

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