MEDICARE: CAROL WOOLMAN I 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	LC1698	ME

General Provider Information

NPI Number	:	1245272962
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CAROL WOOLMAN I LCSW

Provider Business Mailing Address
First Line	:	322 MAIN ST
Second Line	:
City	:	BAR HARBOR
State	:	ME
Zip	:	04609-1637
Country	:	US
Telephone Number	:	207-288-8602
Fax Number	:	207-288-8604

Provider Business Practice Location Address
First Line	:	322 MAIN ST
Second Line	:
City	:	BAR HARBOR
State	:	ME
Zip	:	04609-1637
Country	:	US
Telephone Number	:	207-288-8602
Fax Number	:	207-288-8604

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

Provider Enumeration Date	:	06/11/2006
Last Update Date	:	07/08/2007

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