MEDICARE: MRS. JODY LAMETTA BRESEE MSW, 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	C009777	NC

General Provider Information

NPI Number	:	1598879298
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. JODY LAMETTA BRESEE MSW, LCSW

Provider Business Mailing Address
First Line	:	2000 PERIMETER PARK DR STE 200
Second Line	:
City	:	MORRISVILLE
State	:	NC
Zip	:	27560-8442
Country	:	US
Telephone Number	:	984-215-4110
Fax Number	:

Provider Business Practice Location Address
First Line	:	781 AVENT FERRY RD
Second Line	:
City	:	HOLLY SPRINGS
State	:	NC
Zip	:	27540-7776
Country	:	US
Telephone Number	:	919-552-8914
Fax Number	:	919-552-8955

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

Provider Enumeration Date	:	08/18/2006
Last Update Date	:	05/06/2021

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