MEDICARE: MS. CAROL A. TREADWELL L.C.S.W.

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	LCS18595	CA

General Provider Information

NPI Number	:	1164432019
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. CAROL A. TREADWELL L.C.S.W.

Provider Business Mailing Address
First Line	:	PO BOX 2523
Second Line	:	TIME OUT
City	:	BIG BEAR CITY
State	:	CA
Zip	:	92314-2523
Country	:	US
Telephone Number	:	909-878-4388
Fax Number	:	909-878-4388

Provider Business Practice Location Address
First Line	:	848 PANAMINT MOUNTAIN DRIVE
Second Line	:
City	:	BIG BEAR CITY
State	:	CA
Zip	:	92314-2523
Country	:	US
Telephone Number	:	909-878-4388
Fax Number	:

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

Provider Enumeration Date	:	08/09/2006
Last Update Date	:	07/17/2014

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