MEDICARE: NAOMI MATSUI DE LA CRUZ SPENCER

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	P011555	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	:	1689191983
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NAOMI MATSUI DE LA CRUZ SPENCER

Provider Business Mailing Address
First Line	:	1403 EASTCREST DRIVE
Second Line	:	202
City	:	CHARLOTTE
State	:	NC
Zip	:	28205
Country	:	US
Telephone Number	:	980-277-2349
Fax Number	:	704-817-7139

Provider Business Practice Location Address
First Line	:	322 LAMAR AVE STE 209
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28204-2436
Country	:	US
Telephone Number	:	704-644-9613
Fax Number	:

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

Provider Enumeration Date	:	08/28/2017
Last Update Date	:	10/16/2019

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