MEDICARE: MAGGIE REASONS MSW LCSWA

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

General Provider Information

NPI Number	:	1033762968
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MAGGIE REASONS MSW LCSWA

Provider Business Mailing Address
First Line	:	11843 RIDGEWAY PARK DR
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28277-2989
Country	:	US
Telephone Number	:	704-526-7795
Fax Number	:

Provider Business Practice Location Address
First Line	:	401 SCALEYBARK RD
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28209-2614
Country	:	US
Telephone Number	:	980-237-9731
Fax Number	:

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

Provider Enumeration Date	:	07/19/2019
Last Update Date	:	07/19/2019

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