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NPI Code Detail

MEDICARE: MRS. CATHERINE BLYTHE CLEMMER MSW, LCSW

MEDICARE: MRS. CATHERINE BLYTHE CLEMMER MSW, 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
11041C0700XClinical Social WorkerC005954NC

General Provider Information

NPI Number : 1215105747
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. CATHERINE BLYTHE CLEMMER MSW, LCSW
Provider Business Mailing Address
First Line : 433 W MAIN ST
Second Line :
City : DURHAM
State : NC
Zip : 27701-3217
Country : US
Telephone Number : 919-433-0170
Fax Number :
Provider Business Practice Location Address
First Line : 433 W MAIN ST
Second Line :
City : DURHAM
State : NC
Zip : 27701-3217
Country : US
Telephone Number : 919-433-0170
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/19/2008
Last Update Date : 02/19/2008

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