MEDICARE: CAROLYN RAE KROL 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	0904000986	VA

General Provider Information

NPI Number	:	1275500589
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CAROLYN RAE KROL LCSW

Provider Business Mailing Address
First Line	:	8301 ARLINGTON BLVD
Second Line	:	SUITE 505
City	:	FAIRFAX
State	:	VA
Zip	:	22031-2902
Country	:	US
Telephone Number	:	202-669-3249
Fax Number	:	703-573-5429

Provider Business Practice Location Address
First Line	:	8301 ARLINGTON BLVD
Second Line	:	SUITE 505
City	:	FAIRFAX
State	:	VA
Zip	:	22031-2902
Country	:	US
Telephone Number	:	202-669-3249
Fax Number	:	703-573-5429

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

Provider Enumeration Date	:	03/06/2006
Last Update Date	:	07/08/2007

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