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NPI Code Detail

MEDICARE: MS. SOCORRO MILES MSW, LCSW

MEDICARE: MS. SOCORRO MILES MSW, 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
11041C0700XClinical Social WorkerC009044NC

General Provider Information

NPI Number : 1881939502
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. SOCORRO MILES MSW, LCSW
Provider Business Mailing Address
First Line : 6419 BANNINGTON RD STE B
Second Line :
City : CHARLOTTE
State : NC
Zip : 28226-1341
Country : US
Telephone Number : 919-288-9555
Fax Number :
Provider Business Practice Location Address
First Line : 6419 BANNINGTON RD STE B
Second Line :
City : CHARLOTTE
State : NC
Zip : 28226-1341
Country : US
Telephone Number : 704-533-5810
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/06/2012
Last Update Date : 03/09/2022

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