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NPI Code Detail

MEDICARE: WILLIE RENARD DEVEREAUX SOCIAL WORKER

MEDICARE: WILLIE RENARD DEVEREAUX SOCIAL WORKER
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
1104100000XSocial Worker17842LA

General Provider Information

NPI Number : 1609680529
Entity Type Code : Individual
Provider Name (Legal Business Name) : WILLIE RENARD DEVEREAUX SOCIAL WORKER
Provider Business Mailing Address
First Line : 8012 LEITH CT
Second Line :
City : FORT CAVAZOS
State : TX
Zip : 76544-1792
Country : US
Telephone Number : 706-577-7248
Fax Number :
Provider Business Practice Location Address
First Line : 8012 LEITH CT
Second Line :
City : FORT CAVAZOS
State : TX
Zip : 76544-1792
Country : US
Telephone Number : 706-577-7248
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/03/2025
Last Update Date : 02/03/2025

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Directions to “ WILLIE RENARD DEVEREAUX SOCIAL WORKER” Practice Location

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