MEDICARE: RACHAEL BIANCA MYERS 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	12831	LA

General Provider Information

NPI Number	:	1356851497
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RACHAEL BIANCA MYERS LCSW

Provider Business Mailing Address
First Line	:	1116 SAINT FERDINAND ST
Second Line	:
City	:	NEW ORLEANS
State	:	LA
Zip	:	70117-7233
Country	:	US
Telephone Number	:	406-539-4900
Fax Number	:

Provider Business Practice Location Address
First Line	:	1116 SAINT FERDINAND ST
Second Line	:
City	:	NEW ORLEANS
State	:	LA
Zip	:	70117-7233
Country	:	US
Telephone Number	:	406-539-4900
Fax Number	:

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

Provider Enumeration Date	:	10/03/2017
Last Update Date	:	10/03/2017

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