MEDICARE: VATARA SCOTT 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	C011877	NC

General Provider Information

NPI Number	:	1992241525
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	VATARA SCOTT LCSW

Provider Business Mailing Address
First Line	:	500 BENSON RD # 238
Second Line	:
City	:	GARNER
State	:	NC
Zip	:	27529-3947
Country	:	US
Telephone Number	:	919-583-6627
Fax Number	:

Provider Business Practice Location Address
First Line	:	3735 JUNCTION BLVD
Second Line	:
City	:	RALEIGH
State	:	NC
Zip	:	27603-5263
Country	:	US
Telephone Number	:	919-946-1373
Fax Number	:

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

Provider Enumeration Date	:	01/06/2017
Last Update Date	:	12/10/2022

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