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NPI Code Detail

MEDICARE: RAVEN-SYMONE MOTEN LCSW

MEDICARE: RAVEN-SYMONE MOTEN 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
11041C0700XClinical Social Worker34011052AIN
21041C0700XClinical Social Worker6801117240MI
31041C0700XClinical Social WorkerI.2405232OH

General Provider Information

NPI Number : 1104663509
Entity Type Code : Individual
Provider Name (Legal Business Name) : RAVEN-SYMONE MOTEN LCSW
Provider Business Mailing Address
First Line : 2947 DAISY LN
Second Line :
City : COLUMBUS
State : OH
Zip : 43204-2204
Country : US
Telephone Number : 219-702-6094
Fax Number :
Provider Business Practice Location Address
First Line : 2947 DAISY LN
Second Line :
City : COLUMBUS
State : OH
Zip : 43204-2204
Country : US
Telephone Number : 219-702-6094
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/11/2024
Last Update Date : 07/11/2024

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Directions to “ RAVEN-SYMONE MOTEN LCSW” Practice Location

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