MEDICARE: SATESHA MONIQUE BOONE MSW, 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	P019775	NC

General Provider Information

NPI Number	:	1528847878
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SATESHA MONIQUE BOONE MSW, LCSWA

Provider Business Mailing Address
First Line	:	717 OLD FARM RD S
Second Line	:
City	:	ROANOKE RAPIDS
State	:	NC
Zip	:	27870-5032
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	9425 NC HIGHWAY 305
Second Line	:
City	:	JACKSON
State	:	NC
Zip	:	27845-9679
Country	:	US
Telephone Number	:	252-534-1661
Fax Number	:

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

Provider Enumeration Date	:	09/26/2023
Last Update Date	:	11/08/2023

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