Provider Demographics
NPI:1407001860
Name:WOMACK, JOAN ELAINE (LCSW)
Entity type:Individual
Prefix:MS
First Name:JOAN
Middle Name:ELAINE
Last Name:WOMACK
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5217 OLD SPICEWOOD SPRINGS RD
Mailing Address - Street 2:APT #1104
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78731-1036
Mailing Address - Country:US
Mailing Address - Phone:512-505-8420
Mailing Address - Fax:
Practice Address - Street 1:5217 OLD SPICEWOOD SPRINGS RD
Practice Address - Street 2:APT #1104
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78731-1036
Practice Address - Country:US
Practice Address - Phone:512-505-8420
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-25
Last Update Date:2008-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXS164611041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0639809-01Medicaid
NYJW0873770OtherFINGER LAKES BLUE CROSS BLUE SHIELD
TX013374306-00OtherMAGELLAN BEHAVIORAL HEALTH, HUMANA TEXAS/MEDICARE
TX00S12TMedicare PIN