MEDICARE: MR. SHANE ALAN ARNETT 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	C5022	MS

General Provider Information

NPI Number	:	1629258454
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. SHANE ALAN ARNETT LCSW

Provider Business Mailing Address
First Line	:	PSC 557 BOX 1496
Second Line	:
City	:	FPO
State	:	AP
Zip	:	96379
Country	:	US
Telephone Number	:	601-427-2803
Fax Number	:

Provider Business Practice Location Address
First Line	:	PSC 557 BOX 1496
Second Line	:
City	:	FPO
State	:	AP
Zip	:	96379
Country	:	US
Telephone Number	:	06014272803
Fax Number	:

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

Provider Enumeration Date	:	11/09/2007
Last Update Date	:	10/21/2009

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