MEDICARE: SAMANTHA RAE CARTER 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	104100000X	Social Worker
2	1041C0700X	Clinical Social Worker	12201242-3501	UT

General Provider Information

NPI Number	:	1497385934
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SAMANTHA RAE CARTER LCSW

Provider Business Mailing Address
First Line	:	7394 S UNION CREEK WAY APT 13H
Second Line	:
City	:	MIDVALE
State	:	UT
Zip	:	84047-5915
Country	:	US
Telephone Number	:	609-954-6176
Fax Number	:

Provider Business Practice Location Address
First Line	:	4578 S HIGHLAND DR STE 380
Second Line	:
City	:	MILLCREEK
State	:	UT
Zip	:	84117-4204
Country	:	US
Telephone Number	:	609-954-6176
Fax Number	:

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

Provider Enumeration Date	:	01/23/2020
Last Update Date	:	01/03/2023

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