MEDICARE: CASEY NICOLE JANES MA. 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	58624	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	58624	OTHER	TX	BHEC

General Provider Information

NPI Number	:	1629788971
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CASEY NICOLE JANES MA. LCSW

Provider Business Mailing Address
First Line	:	1710 LONGFIELD
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78248-1212
Country	:	US
Telephone Number	:	210-896-6143
Fax Number	:

Provider Business Practice Location Address
First Line	:	1710 LONGFIELD
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78248-1212
Country	:	US
Telephone Number	:	210-896-6143
Fax Number	:

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

Provider Enumeration Date	:	11/28/2022
Last Update Date	:	04/18/2023

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