MEDICARE: MS. ELAINE M LO SASSO 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	101Y00000X	Counselor	C003272	NC
2	1041C0700X	Clinical Social Worker	C003272	NC

General Provider Information

NPI Number	:	1427274414
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. ELAINE M LO SASSO LCSW

Provider Business Mailing Address
First Line	:	1811 SARDIS RD NORTH
Second Line	:	SUITE 207
City	:	CHARLOTTE
State	:	NC
Zip	:	28270-3000
Country	:	US
Telephone Number	:	704-516-4859
Fax Number	:

Provider Business Practice Location Address
First Line	:	1811 SARDIS RD NORTH
Second Line	:	SUITE 207
City	:	CHARLOTTE
State	:	NC
Zip	:	28270-3000
Country	:	US
Telephone Number	:	704-516-4859
Fax Number	:

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

Provider Enumeration Date	:	04/18/2007
Last Update Date	:	09/11/2025

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