MEDICARE: ANDRA R SOTO 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	95969	CA
2	1041C0700X	Clinical Social Worker	103850	TX

General Provider Information

NPI Number	:	1619385515
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANDRA R SOTO LCSW

Provider Business Mailing Address
First Line	:	107 FANNIN AVE STE 100
Second Line	:
City	:	ROUND ROCK
State	:	TX
Zip	:	78664-5218
Country	:	US
Telephone Number	:	737-243-4531
Fax Number	:

Provider Business Practice Location Address
First Line	:	107 FANNIN AVE STE 100
Second Line	:
City	:	ROUND ROCK
State	:	TX
Zip	:	78664-5218
Country	:	US
Telephone Number	:	737-243-4531
Fax Number	:

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

Provider Enumeration Date	:	07/24/2014
Last Update Date	:	10/25/2023

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Directions to “ ANDRA R SOTO LCSW” Practice Location

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