MEDICARE: MS. CAROLYN LOUISE CREMONA 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	62995	TX

General Provider Information

NPI Number	:	1629648829
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. CAROLYN LOUISE CREMONA LCSW

Provider Business Mailing Address
First Line	:	8019 EXMOOR DR # B
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78757-8228
Country	:	US
Telephone Number	:	512-785-3528
Fax Number	:

Provider Business Practice Location Address
First Line	:	8019 EXMOOR DR # B
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78757-8228
Country	:	US
Telephone Number	:	512-785-3528
Fax Number	:

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

Provider Enumeration Date	:	06/29/2021
Last Update Date	:	06/30/2021

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