MEDICARE: CAROLINE NKECHI OGUINE LCSW-C

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	20474	MD

General Provider Information

NPI Number	:	1184020372
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CAROLINE NKECHI OGUINE LCSW-C

Provider Business Mailing Address
First Line	:	3613 WHITE AVE
Second Line	:
City	:	BALTIMORE
State	:	MD
Zip	:	21206-3413
Country	:	US
Telephone Number	:	443-803-6358
Fax Number	:

Provider Business Practice Location Address
First Line	:	3613 WHITE AVE
Second Line	:
City	:	BALTIMORE
State	:	MD
Zip	:	21206-3413
Country	:	US
Telephone Number	:	443-803-6358
Fax Number	:

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

Provider Enumeration Date	:	11/14/2014
Last Update Date	:	11/14/2014

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