MEDICARE: MR. SCOTT HARRIS HERSHMAN LCSW,LMFT

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	34001057A	IN

General Provider Information

NPI Number	:	1720069107
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. SCOTT HARRIS HERSHMAN LCSW,LMFT

Provider Business Mailing Address
First Line	:	6860 RIDGE TOP DR
Second Line	:
City	:	EL PASO
State	:	TX
Zip	:	79904-3915
Country	:	US
Telephone Number	:	915-759-9458
Fax Number	:

Provider Business Practice Location Address
First Line	:	5005 N PIEDRAS ST
Second Line	:	WBAMC/ATT CREDENTIALS
City	:	EL PASO
State	:	TX
Zip	:	79920-5001
Country	:	US
Telephone Number	:	915-569-1382
Fax Number	:	915-569-1233

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

Provider Enumeration Date	:	11/11/2005
Last Update Date	:	07/08/2007

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