MEDICARE: MS. ANGELA RUSSELL VIESCA 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	S21347	TX

General Provider Information

NPI Number	:	1790956431
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. ANGELA RUSSELL VIESCA LCSW

Provider Business Mailing Address
First Line	:	16401 MARTHAS CV
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78717-3023
Country	:	US
Telephone Number	:	512-293-4346
Fax Number	:	512-293-4346

Provider Business Practice Location Address
First Line	:	595 ROUND ROCK WEST DR STE 103
Second Line	:
City	:	ROUND ROCK
State	:	TX
Zip	:	78681-5028
Country	:	US
Telephone Number	:	512-293-4346
Fax Number	:

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

Provider Enumeration Date	:	03/21/2008
Last Update Date	:	03/02/2026

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