MEDICARE: ANTOINETTE LILLIAN VINCENT 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	104212	TX

General Provider Information

NPI Number	:	1942150370
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANTOINETTE LILLIAN VINCENT LCSW

Provider Business Mailing Address
First Line	:	14930 MUESCHKE RD STE 100
Second Line	:
City	:	CYPRESS
State	:	TX
Zip	:	77433-0980
Country	:	US
Telephone Number	:	346-206-3992
Fax Number	:	832-652-3626

Provider Business Practice Location Address
First Line	:	12234 SHADOW CREEK PKWY STE 10106
Second Line	:
City	:	PEARLAND
State	:	TX
Zip	:	77584-7343
Country	:	US
Telephone Number	:	346-206-3992
Fax Number	:	832-652-3626

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

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

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