MEDICARE: SUE A PERMENTER 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	09140	TX

General Provider Information

NPI Number	:	1902977622
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SUE A PERMENTER LCSW

Provider Business Mailing Address
First Line	:	PO BOX 580601
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77258-0601
Country	:	US
Telephone Number	:	281-333-3010
Fax Number	:

Provider Business Practice Location Address
First Line	:	18100 UPPER BAY RD STE 103
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77058-3530
Country	:	US
Telephone Number	:	281-333-3010
Fax Number	:

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

Provider Enumeration Date	:	11/13/2006
Last Update Date	:	07/08/2007

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Directions to “ SUE A PERMENTER LCSW” Practice Location

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