MEDICARE: MRS. ELIZABETH WILEY KOVACS 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	C008400	NC

General Provider Information

NPI Number	:	1356672851
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. ELIZABETH WILEY KOVACS LCSW

Provider Business Mailing Address
First Line	:	PO BOX 435
Second Line	:
City	:	DAVIDSON
State	:	NC
Zip	:	28036-0435
Country	:	US
Telephone Number	:	704-966-9277
Fax Number	:	980-217-8402

Provider Business Practice Location Address
First Line	:	18139 W CATAWBA AVE STE 2
Second Line	:
City	:	CORNELIUS
State	:	NC
Zip	:	28031-5641
Country	:	US
Telephone Number	:	704-966-9277
Fax Number	:	980-217-8402

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

Provider Enumeration Date	:	01/22/2010
Last Update Date	:	10/21/2019

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