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NPI Code Detail

MEDICARE: CLAIRE IVY LMSW

MEDICARE: CLAIRE IVY LMSW
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
1104100000XSocial WorkerMSW010419GA

General Provider Information

NPI Number : 1336874528
Entity Type Code : Individual
Provider Name (Legal Business Name) : CLAIRE IVY LMSW
Provider Business Mailing Address
First Line : 1907 IVY ST
Second Line :
City : CHATTANOOGA
State : TN
Zip : 37404-2627
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 1638 BATTLEFIELD PKWY
Second Line :
City : FORT OGLETHORPE
State : GA
Zip : 30742-4016
Country : US
Telephone Number : 706-841-0500
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/21/2022
Last Update Date : 07/21/2022

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