MEDICARE: MRS. CAROLYN MORRIS PIERCE LCSW

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	0904005163	VA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	246323	OTHER	VA	ANTHEM

General Provider Information

NPI Number	:	1598784894
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. CAROLYN MORRIS PIERCE LCSW

Provider Business Mailing Address
First Line	:	5104 N BAY HILL CT
Second Line	:
City	:	SUFFOLK
State	:	VA
Zip	:	23435-2679
Country	:	US
Telephone Number	:	757-638-7383
Fax Number	:	757-638-3373

Provider Business Practice Location Address
First Line	:	5104 N BAY HILL CT
Second Line	:
City	:	SUFFOLK
State	:	VA
Zip	:	23435-2679
Country	:	US
Telephone Number	:	757-638-7383
Fax Number	:	757-638-3373

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

Provider Enumeration Date	:	07/18/2006
Last Update Date	:	07/08/2007

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