MEDICARE: STEPHANIE LANCASTER LLC

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

General Provider Information

NPI Number	:	1922595248
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	STEPHANIE LANCASTER LLC

Provider Business Mailing Address
First Line	:	4773 CARROLL CEMETERY RD
Second Line	:
City	:	CARROLL
State	:	OH
Zip	:	43112-9428
Country	:	US
Telephone Number	:	740-617-8162
Fax Number	:

Provider Business Practice Location Address
First Line	:	4773 CARROLL CEMETERY RD
Second Line	:
City	:	CARROLL
State	:	OH
Zip	:	43112-9428
Country	:	US
Telephone Number	:	740-617-8162
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	STEPHANIE LANCASTER
Credential	:	LISW
Telephone Number	:	614-385-2559

Provider Enumeration Date	:	04/23/2018
Last Update Date	:	04/23/2018

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