MEDICARE: MRS. TRACI L NOBLE MSW, 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	34004710A	IN

General Provider Information

NPI Number	:	1184840852
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. TRACI L NOBLE MSW, LCSW

Provider Business Mailing Address
First Line	:	12513 PINTAIL CT
Second Line	:
City	:	CEDAR LAKE
State	:	IN
Zip	:	46303-8603
Country	:	US
Telephone Number	:	219-374-6992
Fax Number	:

Provider Business Practice Location Address
First Line	:	12513 PINTAIL CT
Second Line	:
City	:	CEDAR LAKE
State	:	IN
Zip	:	46303-8603
Country	:	US
Telephone Number	:	219-374-6992
Fax Number	:

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

Provider Enumeration Date	:	04/18/2007
Last Update Date	:	05/29/2015

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