Pedro Bustamante, LMSW
Individual provider Active NPI Social Worker · Georgetown, TX
NPI 1164544128 · NPPES record last updated Jul 8, 2007
Key facts
- NPI
- 1164544128
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Social Worker 104100000X
- License
- S35300 (TX)
- Practice address
- 701 E University Ave
Georgetown, TX 78626-7035 - Phone
- (512) 863-9208
- Fax
- (512) 864-7238
- NPI assigned
- Apr 3, 2007
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 2
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| S35300 | TX | MD | Social Worker |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Lone Star Circle of Care | Past | Accepting new patients | |
| Lone Star Circle of Care | Past | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Social Worker | 104100000X | S35300 | TX | Yes |
Addresses
Primary practice location
701 E University Ave
Georgetown, TX 78626-7035
Mailing address
1506 Amelia Dr
Cedar Park, TX 78613-3218
Phone (512) 336-8682
Other providers in Georgetown, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 8, 2007. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.