Carolyn Jo Bourg is a Clinical in Nederland, Texas. Carolyn Jo Bourg practices all healthcare services and medical treatments related to Clinical. The NPI Number for Carolyn Jo Bourg is 1962507293. The last update date is 2007-07-09.
Carolyn Jo Bourg's current location address is 3005 Avenue H, Nederland, Texas. You can contact this provider via phone number 4097241920. The mailing address for Carolyn Jo Bourg is 3005 Avenue H, Nederland, Texas. To know further, please read the information below!
Provider Profile Detail
| Provider Name | Carolyn Jo Bourg |
|---|---|
| Address | 3005 Avenue H, Nederland, Texas |
| Phone Number | 4097241920 |
| Fax Number | |
| Sole Proprietor | N |
| Credentials | LCSW-BCD |
NPI Number Detail
| NPI Number | 1962507293 |
|---|---|
| Provider Enumeration Date | 2006-09-13 |
| Last Updated Date | 2007-07-09 |
Provider Mailing Address Detail
| Address | 3005 Avenue H |
|---|---|
| City | Nederland |
| State | Texas (TX) |
| Post Code | 776277607 |
| Phone Number | 4097241920 |
| Fax Number |
Provider's Primary Taxonomy Detail
| Speciality | Clinical |
|---|---|
| Taxonomy | 1041C0700X |
| Licence No | 11947 |
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Definition: A social worker who holds a master's or doctoral degree in social work from an accredited school of social work in addition to at least two years of post-master's supervised experience in a clinical setting. The social worker must be licensed, certif |
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What is the unique 10-digit identification code issued to Carolyn Jo Bourg by the Centers for Medicare & Medicaid Services?
The Carolyn Jo Bourg has been assigned the NPI (National Provider Identifier) 1962507293 by the Centers for Medicare & Medicaid Services (CMS). This 10-digit code serves as a unique identifier for healthcare providers.
Could you please share the complete physical location address where Carolyn Jo Bourg's facilities are situated?
The facilities of Carolyn Jo Bourg are physically located at the following address: 3005 Avenue H, Nederland, TX, 776277607.
What is the Carolyn Jo Bourg's area of specialization and corresponding taxonomy classification?
The Carolyn Jo Bourg's specialty field is Clinical, and it falls under the taxonomy code 1041C0700X, which categorizes healthcare providers based on their specialties.
On what date was the 1962507293 assigned to Carolyn Jo Bourg?
The Carolyn Jo Bourg was issued its 1962507293 on 2006-09-13, which is the date when this unique identifier was assigned to the organization by the Centers for Medicare & Medicaid Services.
When was the information regarding Carolyn Jo Bourg, such as address, specialty, and other details, most recently verified or confirmed to be accurate?
The information pertaining to Carolyn Jo Bourg, including its address, specialty, and other relevant details, was most recently verified or confirmed to be accurate on 2007-07-09.