MEDICARE: CARRIE CRAVENS LSCW

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	0904015092	VA
2	1041C0700X	Clinical Social Worker	2019010079	MO

General Provider Information

NPI Number	:	1003109265
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CARRIE CRAVENS LSCW

Provider Business Mailing Address
First Line	:	6900 ALDEN DR
Second Line	:
City	:	FE WARREN AFB
State	:	WY
Zip	:	82005-2945
Country	:	US
Telephone Number	:	307-773-4337
Fax Number	:

Provider Business Practice Location Address
First Line	:	6900 ALDEN DR
Second Line	:
City	:	FE WARREN AFB
State	:	WY
Zip	:	82005-2945
Country	:	US
Telephone Number	:	307-773-4337
Fax Number	:

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

Provider Enumeration Date	:	05/20/2011
Last Update Date	:	08/21/2023

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