MEDICARE: DALE SPEAR GARSON 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	CW015082	PA

General Provider Information

NPI Number	:	1700956224
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DALE SPEAR GARSON LCSW

Provider Business Mailing Address
First Line	:	5 ANDORRA HILL RD
Second Line	:
City	:	LAFAYETTE HILL
State	:	PA
Zip	:	19444-1705
Country	:	US
Telephone Number	:	610-329-9897
Fax Number	:	610-832-5332

Provider Business Practice Location Address
First Line	:	5 ANDORRA HILL RD
Second Line	:
City	:	LAFAYETTE HILL
State	:	PA
Zip	:	19444-1705
Country	:	US
Telephone Number	:	610-329-9897
Fax Number	:	610-832-5332

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

Provider Enumeration Date	:	11/09/2006
Last Update Date	:	07/08/2007

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