MEDICARE: MRS. CARRIE A SELLERS LISW

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	I 0700059-S	OH

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

General Provider Information

NPI Number	:	1326203928
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. CARRIE A SELLERS LISW

Provider Business Mailing Address
First Line	:	1392 HIGH ST STE 205
Second Line	:
City	:	WADSWORTH
State	:	OH
Zip	:	44281-8257
Country	:	US
Telephone Number	:	330-227-4518
Fax Number	:	855-975-3166

Provider Business Practice Location Address
First Line	:	1392 HIGH ST STE 205
Second Line	:
City	:	WADSWORTH
State	:	OH
Zip	:	44281-8257
Country	:	US
Telephone Number	:	330-227-4518
Fax Number	:	855-975-3166

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

Provider Enumeration Date	:	07/23/2008
Last Update Date	:	03/01/2023

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