MEDICARE: MRS. VANESSA DANIELL LADRIE 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	C006156	NC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1053560730
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. VANESSA DANIELL LADRIE LCSW

Provider Business Mailing Address
First Line	:	1309 LAGERFELD WAY
Second Line	:
City	:	WAKE FOREST
State	:	NC
Zip	:	27587-1643
Country	:	US
Telephone Number	:	919-452-5202
Fax Number	:

Provider Business Practice Location Address
First Line	:	8400 SIX FORKS RD
Second Line	:	SUITE 203
City	:	RALEIGH
State	:	NC
Zip	:	27615-3068
Country	:	US
Telephone Number	:	919-452-5202
Fax Number	:

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

Provider Enumeration Date	:	09/17/2008
Last Update Date	:	04/24/2011

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