MEDICARE: ABBIE BYRD HANCOCK 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	61899	TX

General Provider Information

NPI Number	:	1801515259
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ABBIE BYRD HANCOCK LCSW

Provider Business Mailing Address
First Line	:	9308 AUBREE CT
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76140-5169
Country	:	US
Telephone Number	:	682-208-4087
Fax Number	:

Provider Business Practice Location Address
First Line	:	9308 AUBREE CT
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76140-5169
Country	:	US
Telephone Number	:	682-208-4087
Fax Number	:

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

Provider Enumeration Date	:	08/26/2022
Last Update Date	:	08/26/2022

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