MEDICARE: MR. MICHAEL CLAYTON CAROTHERS LSW

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	SW137372	PA

General Provider Information

NPI Number	:	1699380337
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. MICHAEL CLAYTON CAROTHERS LSW

Provider Business Mailing Address
First Line	:	19 E FRONT ST
Second Line	:
City	:	OIL CITY
State	:	PA
Zip	:	16301-2363
Country	:	US
Telephone Number	:	814-678-6900
Fax Number	:

Provider Business Practice Location Address
First Line	:	19 E FRONT ST
Second Line	:
City	:	OIL CITY
State	:	PA
Zip	:	16301-2363
Country	:	US
Telephone Number	:	814-678-6900
Fax Number	:

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

Provider Enumeration Date	:	09/10/2020
Last Update Date	:	09/10/2020

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