MEDICARE: REVA E CARTER 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	28337	TX

General Provider Information

NPI Number	:	1184058893
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	REVA E CARTER LCSW

Provider Business Mailing Address
First Line	:	4686 BRISTOL TRACE TRL
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76244-6947
Country	:	US
Telephone Number	:	214-564-7722
Fax Number	:	214-372-4014

Provider Business Practice Location Address
First Line	:	6923 TRAILCREST PL
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75232-3554
Country	:	US
Telephone Number	:	214-564-7722
Fax Number	:	214-372-4014

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

Provider Enumeration Date	:	08/29/2013
Last Update Date	:	08/29/2013

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Directions to “ REVA E CARTER LCSW” Practice Location

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