MEDICARE: MR. JAMES S RANKIN 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	104100000X	Social Worker	CW017502	PA
2	1041C0700X	Clinical Social Worker	CW017502	PA
3	1041C0700X	Clinical Social Worker	19510	AZ

General Provider Information

NPI Number	:	1063741288
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. JAMES S RANKIN LCSW

Provider Business Mailing Address
First Line	:	1659 W FLINTLOCK DR
Second Line	:
City	:	SAN TAN VALLEY
State	:	AZ
Zip	:	85144-0027
Country	:	US
Telephone Number	:	484-769-5624
Fax Number	:	717-236-7600

Provider Business Practice Location Address
First Line	:	1659 W FLINTLOCK DR
Second Line	:
City	:	SAN TAN VALLEY
State	:	AZ
Zip	:	85144-0027
Country	:	US
Telephone Number	:	484-769-5624
Fax Number	:

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

Provider Enumeration Date	:	12/17/2009
Last Update Date	:	11/04/2024

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