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NPI Code Detail

MEDICARE: ANDREW DUCKWORTH LCSW

MEDICARE: ANDREW DUCKWORTH 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
1101YM0800XMental Health Counselor
21041C0700XClinical Social Worker149023515IL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1101YM0800XOTHERTAXONOMY

General Provider Information

NPI Number : 1609476134
Entity Type Code : Individual
Provider Name (Legal Business Name) : ANDREW DUCKWORTH LCSW
Provider Business Mailing Address
First Line : 1315 S ADAMS ST
Second Line :
City : FORT WORTH
State : TX
Zip : 76104-4404
Country : US
Telephone Number : 833-484-6359
Fax Number :
Provider Business Practice Location Address
First Line : 1315 S ADAMS ST
Second Line :
City : FORT WORTH
State : TX
Zip : 76104-4404
Country : US
Telephone Number : 833-484-6359
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/26/2020
Last Update Date : 12/14/2023

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Directions to “ ANDREW DUCKWORTH LCSW” Practice Location

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