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NPI Code Detail

MEDICARE: ZITA CARROLL LCSW

MEDICARE:   ZITA  CARROLL  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
11041C0700XClinical Social WorkerCW017959PA

General Provider Information

NPI Number : 1669970380
Entity Type Code : Individual
Provider Name (Legal Business Name) : ZITA CARROLL LCSW
Provider Business Mailing Address
First Line : 255 S 17TH ST STE 603
Second Line :
City : PHILADELPHIA
State : PA
Zip : 19103-6206
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 255 S 17TH ST STE 603
Second Line :
City : PHILADELPHIA
State : PA
Zip : 19103-6206
Country : US
Telephone Number : 215-767-7198
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/28/2018
Last Update Date : 01/28/2018

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Directions to “ ZITA CARROLL LCSW” Practice Location

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