MEDICARE: KATELYN MARIE SWAN LCSW

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	C016659	NC

General Provider Information

NPI Number	:	1174196661
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KATELYN MARIE SWAN LCSW

Provider Business Mailing Address
First Line	:	2815 CATES AVE
Second Line	:
City	:	RALEIGH
State	:	NC
Zip	:	27695-0001
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2815 CATES AVE
Second Line	:
City	:	RALEIGH
State	:	NC
Zip	:	27695-4842
Country	:	US
Telephone Number	:	919-515-4023
Fax Number	:

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

Provider Enumeration Date	:	07/21/2021
Last Update Date	:	01/06/2025

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