MEDICARE: PRISCILLE JEAN ELUSME LCSWA

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	P015749	NC

General Provider Information

NPI Number	:	1093252405
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PRISCILLE JEAN ELUSME LCSWA

Provider Business Mailing Address
First Line	:	284 EXECUTIVE PARK DR STE 100
Second Line	:
City	:	CONCORD
State	:	NC
Zip	:	28025-1833
Country	:	US
Telephone Number	:	704-939-1100
Fax Number	:	704-939-1173

Provider Business Practice Location Address
First Line	:	701 E ROOSEVELT BLVD STE 600
Second Line	:
City	:	MONROE
State	:	NC
Zip	:	28112-4106
Country	:	US
Telephone Number	:	47-296-6200
Fax Number	:

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

Provider Enumeration Date	:	01/23/2017
Last Update Date	:	03/11/2025

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