MEDICARE: CARISA SELLERS

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	CSW005389	GA
2	1041C0700X	Clinical Social Worker	63347	TX

General Provider Information

NPI Number	:	1659756674
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CARISA SELLERS

Provider Business Mailing Address
First Line	:	9810 DARTMOOR PONY
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78254-4707
Country	:	US
Telephone Number	:	404-578-0605
Fax Number	:

Provider Business Practice Location Address
First Line	:	9810 DARTMOOR PONY
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78254-4707
Country	:	US
Telephone Number	:	404-578-0605
Fax Number	:

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

Provider Enumeration Date	:	07/21/2015
Last Update Date	:	09/09/2024

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Directions to “ CARISA SELLERS ” Practice Location

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