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NPI Code Detail

MEDICARE: ERIC RANKIN PH.D., LICSW

MEDICARE: ERIC RANKIN PH.D., LICSW
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 WorkerDP00080149WV

General Provider Information

NPI Number : 1689647323
Entity Type Code : Individual
Provider Name (Legal Business Name) : ERIC RANKIN PH.D., LICSW
Provider Business Mailing Address
First Line : PO BOX 897
Second Line :
City : MORGANTOWN
State : WV
Zip : 26507-0897
Country : US
Telephone Number : 304-293-7401
Fax Number : 304-293-6963
Provider Business Practice Location Address
First Line : 930 CHESTNUT RIDGE RD
Second Line :
City : MORGANTOWN
State : WV
Zip : 26505-2807
Country : US
Telephone Number : 304-598-4214
Fax Number : 304-293-6963
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/13/2006
Last Update Date : 07/08/2007

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