MEDICARE: MS. SUSAN JANET CLIFTON 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	C002933	NC

General Provider Information

NPI Number	:	1477930378
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. SUSAN JANET CLIFTON LCSW

Provider Business Mailing Address
First Line	:	2130 FOREST HILLS RD W STE A
Second Line	:
City	:	WILSON
State	:	NC
Zip	:	27893-3681
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2130 FOREST HILLS RD W STE A
Second Line	:
City	:	WILSON
State	:	NC
Zip	:	27893-3681
Country	:	US
Telephone Number	:	252-265-9200
Fax Number	:

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

Provider Enumeration Date	:	04/29/2015
Last Update Date	:	04/29/2015

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