MEDICARE: DIANE CAROL RAMBEAU 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	C012821	NC

General Provider Information

NPI Number	:	1699375477
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DIANE CAROL RAMBEAU LCSW

Provider Business Mailing Address
First Line	:	6547 RAMSEY FORD RD
Second Line	:
City	:	TABOR CITY
State	:	NC
Zip	:	28463-9316
Country	:	US
Telephone Number	:	410-299-6571
Fax Number	:

Provider Business Practice Location Address
First Line	:	6547 RAMSEY FORD RD
Second Line	:
City	:	TABOR CITY
State	:	NC
Zip	:	28463-9316
Country	:	US
Telephone Number	:	410-299-6571
Fax Number	:

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

Provider Enumeration Date	:	10/29/2020
Last Update Date	:	10/29/2020

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