MEDICARE: RAE MARIE MARSH 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	1041S0200X	School Social Worker	1105051	NC
2	1041C0700X	Clinical Social Worker	C009941	NC

General Provider Information

NPI Number	:	1174943419
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RAE MARIE MARSH LCSW

Provider Business Mailing Address
First Line	:	2538 GREAT DAISY LN
Second Line	:
City	:	NEW HILL
State	:	NC
Zip	:	27562-9353
Country	:	US
Telephone Number	:	919-438-0837
Fax Number	:

Provider Business Practice Location Address
First Line	:	2538 GREAT DAISY LN
Second Line	:
City	:	NEW HILL
State	:	NC
Zip	:	27562-9353
Country	:	US
Telephone Number	:	919-438-0837
Fax Number	:

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

Provider Enumeration Date	:	04/25/2014
Last Update Date	:	08/16/2021

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