MEDICARE: MS. SUSAN CARNAHAN HAWTHORNE 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	S20413	TX

General Provider Information

NPI Number	:	1679797096
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. SUSAN CARNAHAN HAWTHORNE LCSW

Provider Business Mailing Address
First Line	:	5944 LUTHER LN STE 402
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75225-5916
Country	:	US
Telephone Number	:	214-368-8133
Fax Number	:	214-368-1333

Provider Business Practice Location Address
First Line	:	5944 LUTHER LN
Second Line	:	SUITE402
City	:	DALLAS
State	:	TX
Zip	:	75225-5942
Country	:	US
Telephone Number	:	214-368-8133
Fax Number	:	214-368-1333

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

Provider Enumeration Date	:	04/13/2007
Last Update Date	:	07/08/2007

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