Healthcare Provider Details

I. General information

NPI: 1225176001
Provider Name (Legal Business Name): RENEE M MUSCATO LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/02/2007
Last Update Date: 08/24/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3973 MOUNT BEULAH RD
SHERRILLS FORD NC
28673-9795
US

IV. Provider business mailing address

3973 MOUNT BEULAH RD
SHERRILLS FORD NC
28673-9795
US

V. Phone/Fax

Practice location:
  • Phone: 704-999-4719
  • Fax:
Mailing address:
  • Phone: 704-999-4719
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberC004548
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: