MEDICARE: DOLPH BENJAMIN SEARS JR. LICSW

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	15007	MN

General Provider Information

NPI Number	:	1124688577
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DOLPH BENJAMIN SEARS JR. LICSW

Provider Business Mailing Address
First Line	:	314 W SUPERIOR ST STE 400
Second Line	:
City	:	DULUTH
State	:	MN
Zip	:	55802-1892
Country	:	US
Telephone Number	:	218-723-8444
Fax Number	:	218-529-3440

Provider Business Practice Location Address
First Line	:	314 W SUPERIOR ST STE 400
Second Line	:
City	:	DULUTH
State	:	MN
Zip	:	55802-1892
Country	:	US
Telephone Number	:	218-723-8444
Fax Number	:	218-529-3440

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

Provider Enumeration Date	:	06/18/2019
Last Update Date	:	06/18/2019

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