MEDICARE: ANDREW ETUK 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	52847	TX

General Provider Information

NPI Number	:	1982099511
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANDREW ETUK LCSW

Provider Business Mailing Address
First Line	:	10333 HARWIN DR 535D
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77036-1532
Country	:	US
Telephone Number	:	713-482-1029
Fax Number	:

Provider Business Practice Location Address
First Line	:	10333 HARWIN DR 535D
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77036-1532
Country	:	US
Telephone Number	:	713-482-1029
Fax Number	:

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

Provider Enumeration Date	:	03/31/2015
Last Update Date	:	11/02/2015

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