Healthcare Provider Details

I. General information

NPI: 1083781116
Provider Name (Legal Business Name): CAROL RETSCH-BOGART LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/30/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2200 WEST MAIN STREET SUITE 700
DURHAM NC
27705-4640
US

IV. Provider business mailing address

BOX 3834 DUMC
DURHAM NC
27710-0001
US

V. Phone/Fax

Practice location:
  • Phone: 919-416-1727
  • Fax: 919-286-1121
Mailing address:
  • Phone: 919-416-1727
  • Fax: 919-286-1121

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberC000395
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: