MEDICARE: MR. NICHOLAS RAYMOND CAROTENUTO LCSWA

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	P006322	NC

General Provider Information

NPI Number	:	1295159390
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. NICHOLAS RAYMOND CAROTENUTO LCSWA

Provider Business Mailing Address
First Line	:	910 LITTLELEAF LN
Second Line	:
City	:	DURHAM
State	:	NC
Zip	:	27713-9252
Country	:	US
Telephone Number	:	919-260-8305
Fax Number	:

Provider Business Practice Location Address
First Line	:	4102 BEAUFAIN ST
Second Line	:
City	:	RALEIGH
State	:	NC
Zip	:	27604-5074
Country	:	US
Telephone Number	:	919-798-4800
Fax Number	:

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

Provider Enumeration Date	:	02/10/2014
Last Update Date	:	02/10/2014

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