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NPI Code Detail

MEDICARE: SHERMAN BERNARD BOONE

MEDICARE: SHERMAN BERNARD BOONE
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
11041C0700XClinical Social WorkerC005669NC

General Provider Information

NPI Number : 1659589430
Entity Type Code : Organization
Provider Name (Legal Business Name) : SHERMAN BERNARD BOONE
Provider Business Mailing Address
First Line : 1220 SOUTHGATE DR
Second Line :
City : RALEIGH
State : NC
Zip : 27610-5095
Country : US
Telephone Number : 919-623-5502
Fax Number :
Provider Business Practice Location Address
First Line : 607 WASHINGTON ST
Second Line :
City : WILLIAMSTON
State : NC
Zip : 27892-2645
Country : US
Telephone Number : 919-623-5502
Fax Number :
Authorized Official
Title or Position : CEO,THERAPIST
Name : SHERMAN BERNARD BOONE
Credential : LCSW
Telephone Number : 919-623-5502
Provider Enumeration Date : 05/18/2007
Last Update Date : 06/24/2008

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