MEDICARE: MS. RENEE M MUSCATO 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	C004548	NC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	136J1	OTHER	NC	BLUECROSS BLUESHIELD
3	E1603	OTHER		MEDCOST

General Provider Information

NPI Number	:	1225176001
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. RENEE M MUSCATO LCSW

Provider Business Mailing Address
First Line	:	3973 MOUNT BEULAH RD
Second Line	:
City	:	SHERRILLS FORD
State	:	NC
Zip	:	28673-9795
Country	:	US
Telephone Number	:	704-999-4719
Fax Number	:

Provider Business Practice Location Address
First Line	:	3973 MOUNT BEULAH RD
Second Line	:
City	:	SHERRILLS FORD
State	:	NC
Zip	:	28673-9795
Country	:	US
Telephone Number	:	704-999-4719
Fax Number	:

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

Provider Enumeration Date	:	02/02/2007
Last Update Date	:	08/24/2009

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