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NPI Code Detail

MEDICARE: MRS. ANGELA VENSOR-CUSHMAN LCSW

MEDICARE: MRS. ANGELA VENSOR-CUSHMAN 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
11041C0700XClinical Social Worker6796-CNV
21041C0700XClinical Social Worker59621TX

General Provider Information

NPI Number : 1588922587
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. ANGELA VENSOR-CUSHMAN LCSW
Provider Business Mailing Address
First Line : 4201 MEDICAL DR STE 330
Second Line :
City : SAN ANTONIO
State : TX
Zip : 78229-5805
Country : US
Telephone Number : 702-902-9884
Fax Number :
Provider Business Practice Location Address
First Line : 4201 MEDICAL DR STE 330
Second Line :
City : SAN ANTONIO
State : TX
Zip : 78229-5805
Country : US
Telephone Number : 702-902-9884
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/26/2012
Last Update Date : 10/20/2021

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