MEDICARE: MR. CAREY MAHER

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

General Provider Information

NPI Number	:	1649411919
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. CAREY MAHER

Provider Business Mailing Address
First Line	:	107 SCALEYBARK RD
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28209-2608
Country	:	US
Telephone Number	:	704-567-8690
Fax Number	:	704-536-6030

Provider Business Practice Location Address
First Line	:	107 SCALEYBARK RD
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28209-2608
Country	:	US
Telephone Number	:	704-567-8690
Fax Number	:	704-536-6030

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

Provider Enumeration Date	:	03/17/2009
Last Update Date	:	03/17/2009

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