MEDICARE: MS. CATHERINE AVERY HALLETT M.S.W.

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	4234	SC

General Provider Information

NPI Number	:	1376553313
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. CATHERINE AVERY HALLETT M.S.W.

Provider Business Mailing Address
First Line	:	204 W HILL BLVD
Second Line	:
City	:	CHARLESTON
State	:	SC
Zip	:	29404-4704
Country	:	US
Telephone Number	:	843-963-6852
Fax Number	:	843-963-6501

Provider Business Practice Location Address
First Line	:	204 W HILL BLVD
Second Line	:
City	:	CHARLESTON
State	:	SC
Zip	:	29404-4704
Country	:	US
Telephone Number	:	843-963-6852
Fax Number	:	843-963-6501

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

Provider Enumeration Date	:	08/09/2006
Last Update Date	:	04/19/2018

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