MEDICARE: CAROL D WARNER LCSW LLC

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

General Provider Information

NPI Number	:	1578152757
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CAROL D WARNER LCSW LLC

Provider Business Mailing Address
First Line	:	2910 N SWAN RD STE 202
Second Line	:
City	:	TUCSON
State	:	AZ
Zip	:	85712-6011
Country	:	US
Telephone Number	:	520-235-5772
Fax Number	:	520-989-0623

Provider Business Practice Location Address
First Line	:	2910 N SWAN RD STE 202
Second Line	:
City	:	TUCSON
State	:	AZ
Zip	:	85712-6011
Country	:	US
Telephone Number	:	520-235-5772
Fax Number	:	520-989-0623

Authorized Official
Title or Position	:	CLINICAL SOCIAL WORKER
Name	:	MS. CAROL DIANNE WARNER
Credential	:	LCSW
Telephone Number	:	520-235-5772

Provider Enumeration Date	:	01/13/2021
Last Update Date	:	01/13/2021

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