MEDICARE: MS. RACHELLE WILLIA YOUNG CARTER LISW

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	I0000372	OH

General Provider Information

NPI Number	:	1962636290
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. RACHELLE WILLIA YOUNG CARTER LISW

Provider Business Mailing Address
First Line	:	588 E 106TH ST
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44108-1389
Country	:	US
Telephone Number	:	216-451-2222
Fax Number	:

Provider Business Practice Location Address
First Line	:	588 E 106TH ST
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44108-1389
Country	:	US
Telephone Number	:	216-451-2222
Fax Number	:

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

Provider Enumeration Date	:	05/14/2009
Last Update Date	:	05/14/2009

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