MEDICARE: MS. DAWN M. CARLOCK L.C.S.W.

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	CW015461	PA

General Provider Information

NPI Number	:	1760553358
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. DAWN M. CARLOCK L.C.S.W.

Provider Business Mailing Address
First Line	:	20 EVERGREEN LN
Second Line	:
City	:	HADDONFIELD
State	:	NJ
Zip	:	08033-1202
Country	:	US
Telephone Number	:	215-983-5970
Fax Number	:

Provider Business Practice Location Address
First Line	:	514 S 4TH ST
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19147-1507
Country	:	US
Telephone Number	:	215-983-5970
Fax Number	:	215-922-2715

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

Provider Enumeration Date	:	11/13/2006
Last Update Date	:	02/23/2010

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