MEDICARE: CAROLYN VIRGINIA TREIBLEY CLARKE

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

General Provider Information

NPI Number	:	1366196677
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CAROLYN VIRGINIA TREIBLEY CLARKE

Provider Business Mailing Address
First Line	:	8003 FRANKLIN FARMS DR RM 101
Second Line	:
City	:	RICHMOND
State	:	VA
Zip	:	23229-5107
Country	:	US
Telephone Number	:	804-716-0428
Fax Number	:

Provider Business Practice Location Address
First Line	:	8003 FRANKLIN FARMS DR RM 101
Second Line	:
City	:	RICHMOND
State	:	VA
Zip	:	23229-5107
Country	:	US
Telephone Number	:	804-716-0428
Fax Number	:

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

Provider Enumeration Date	:	02/06/2022
Last Update Date	:	02/01/2024

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