MEDICARE: ROSALIND B HARALSON 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	CSW001848	GA

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	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1255620027
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ROSALIND B HARALSON LCSW

Provider Business Mailing Address
First Line	:	1353 GEORGE W BRUMLEY WAY SE
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30317-1743
Country	:	US
Telephone Number	:	404-523-2500
Fax Number	:

Provider Business Practice Location Address
First Line	:	35 WHITEFOORD AVE SE
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30317-1727
Country	:	US
Telephone Number	:	404-588-0104
Fax Number	:

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

Provider Enumeration Date	:	04/01/2011
Last Update Date	:	10/03/2011

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