| Sarah Marie Fanucci, LCSW, LICSW | |
|
4410 Dawn Ave, Odessa, TX 79762-5740 | |
| (360) 303-0958 | |
| Not Available |
| Full Name | Sarah Marie Fanucci |
|---|---|
| Gender | Female |
| Speciality | Social Worker - Clinical |
| Location | 4410 Dawn Ave, Odessa, Texas |
| Accepts Medicare Assignments | Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs. |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1164166245 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | LW60822217 (Washington) | Secondary |
| 1041C0700X | Social Worker - Clinical | 67568 (Texas) | Primary |
| Entity Name | Live Oak Collective Llc |
|---|---|
| Entity Type | Part B Supplier - Clinic/group Practice |
| Entity Identifiers | NPI Number: 1841944857 PECOS PAC ID: 9133516404 Enrollment ID: O20220505000884 |
| Mailing Address | Practice Location Address |
|---|---|
| Sarah Marie Fanucci, LCSW, LICSW 4410 Dawn Ave, Odessa, TX 79762-5740 Ph: (360) 303-0958 | Sarah Marie Fanucci, LCSW, LICSW 4410 Dawn Ave, Odessa, TX 79762-5740 Ph: (360) 303-0958 |
Kathryn Fritts, LCSW Clinical Social Worker Medicare: Not Enrolled in Medicare Practice Location: 419 N Jackson Ave, Odessa, TX 79761 Phone: 432-895-1010 | |
David Munger, LCSW Clinical Social Worker Medicare: Not Enrolled in Medicare Practice Location: 8601 Harvard Ave, Odessa, TX 79765 Phone: 432-553-0346 | |
Erica Marie Rodriguez, LCSW Clinical Social Worker Medicare: Not Enrolled in Medicare Practice Location: 4241 Tanglewood Ln, Odessa, TX 79762 Phone: 432-580-7006 Fax: 432-332-4742 |