MEDICARE: CAROL L POWELL MSW, LISW-S, 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
1	1041C0700X	Clinical Social Worker	I.1500840-SUPV	OH
2	1041C0700X	Clinical Social Worker	34006543A	IN
3	1041C0700X	Clinical Social Worker	253291	KY

General Provider Information

NPI Number	:	1881952463
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CAROL L POWELL MSW, LISW-S, LCSW

Provider Business Mailing Address
First Line	:	525 W 5TH ST STE 322
Second Line	:
City	:	COVINGTON
State	:	KY
Zip	:	41011-1260
Country	:	US
Telephone Number	:	513-901-1050
Fax Number	:	859-786-1812

Provider Business Practice Location Address
First Line	:	525 W 5TH ST STE 322
Second Line	:
City	:	COVINGTON
State	:	KY
Zip	:	41011-1260
Country	:	US
Telephone Number	:	513-901-1050
Fax Number	:	859-786-1812

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

Provider Enumeration Date	:	05/02/2012
Last Update Date	:	12/13/2023

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