MEDICARE: MARY SORRELS 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	1041C0700X	Clinical Social Worker	29443	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1598788010
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARY SORRELS LCSW

Provider Business Mailing Address
First Line	:	PO BOX 3548
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78764-3548
Country	:	US
Telephone Number	:	512-445-7787
Fax Number	:	512-440-4059

Provider Business Practice Location Address
First Line	:	1643 E 2ND ST
Second Line	:	BUILDING C
City	:	AUSTIN
State	:	TX
Zip	:	78702-4411
Country	:	US
Telephone Number	:	512-445-7787
Fax Number	:	512-440-4059

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

Provider Enumeration Date	:	07/25/2006
Last Update Date	:	10/01/2008

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