MEDICARE: CARRIE JOHANNA BIELY 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	99746	CA

General Provider Information

NPI Number	:	1518546787
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CARRIE JOHANNA BIELY LCSW

Provider Business Mailing Address
First Line	:	PO BOX 90221
Second Line	:
City	:	LONG BEACH
State	:	CA
Zip	:	90809-0221
Country	:	US
Telephone Number	:	562-400-2977
Fax Number	:

Provider Business Practice Location Address
First Line	:	842 W 19TH ST
Second Line	:
City	:	LONG BEACH
State	:	CA
Zip	:	90806-5208
Country	:	US
Telephone Number	:	562-400-2977
Fax Number	:

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

Provider Enumeration Date	:	04/05/2021
Last Update Date	:	04/05/2021

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