MEDICARE: MELISSA A EMMERTH 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	104100000X	Social Worker	39040	TX
2	1041C0700X	Clinical Social Worker	39040	TX

General Provider Information

NPI Number	:	1538367446
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MELISSA A EMMERTH LCSW

Provider Business Mailing Address
First Line	:	13305 BROADMEADE AVE
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78729-1918
Country	:	US
Telephone Number	:	512-527-4279
Fax Number	:

Provider Business Practice Location Address
First Line	:	5006 EILERS AVE
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78751-2629
Country	:	US
Telephone Number	:	512-527-4279
Fax Number	:

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

Provider Enumeration Date	:	07/03/2007
Last Update Date	:	04/27/2021

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