MEDICARE: ABENA BEDIAKO 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	C005909	NC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1598940769
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ABENA BEDIAKO LCSW

Provider Business Mailing Address
First Line	:	PO BOX 11354
Second Line	:
City	:	DURHAM
State	:	NC
Zip	:	27703-0354
Country	:	US
Telephone Number	:	919-672-0712
Fax Number	:	888-806-1537

Provider Business Practice Location Address
First Line	:	113 MURRAY HILL DR
Second Line	:
City	:	DURHAM
State	:	NC
Zip	:	27712-3063
Country	:	US
Telephone Number	:	919-672-0712
Fax Number	:	888-806-1537

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

Provider Enumeration Date	:	01/07/2008
Last Update Date	:	12/08/2009

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