MEDICARE: ELENA SOLANO BENNETT L.C.S.W.

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	55653	TX

General Provider Information

NPI Number	:	1942618640
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ELENA SOLANO BENNETT L.C.S.W.

Provider Business Mailing Address
First Line	:	4101 MEDICAL PKWY
Second Line	:	SUITE 109
City	:	AUSTIN
State	:	TX
Zip	:	78756-3734
Country	:	US
Telephone Number	:	512-222-9701
Fax Number	:	512-201-2991

Provider Business Practice Location Address
First Line	:	4101 MEDICAL PKWY
Second Line	:	SUITE 109
City	:	AUSTIN
State	:	TX
Zip	:	78756-3734
Country	:	US
Telephone Number	:	512-222-9701
Fax Number	:	512-201-2991

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

Provider Enumeration Date	:	07/25/2014
Last Update Date	:	07/25/2014

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