MEDICARE: JOSEPHINE SALAZAR 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	18958	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	87715Q	OTHER	TX	BCBS PROVIDER NUMBER

General Provider Information

NPI Number	:	1629291224
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOSEPHINE SALAZAR LCSW

Provider Business Mailing Address
First Line	:	5918 EFFINGHAM DR
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77035-4144
Country	:	US
Telephone Number	:	713-858-8259
Fax Number	:

Provider Business Practice Location Address
First Line	:	5918 EFFINGHAM DRIVE
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77035
Country	:	US
Telephone Number	:	713-858-8259
Fax Number	:

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

Provider Enumeration Date	:	04/11/2007
Last Update Date	:	03/01/2013

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