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NPI Code Detail

MEDICARE: ALISHA RIASATI MSW, LCSWA

MEDICARE: ALISHA RIASATI MSW, LCSWA
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 Worker

General Provider Information

NPI Number : 1700176559
Entity Type Code : Individual
Provider Name (Legal Business Name) : ALISHA RIASATI MSW, LCSWA
Provider Business Mailing Address
First Line : 4609 KAVANAUGH DR
Second Line :
City : CHARLOTTE
State : NC
Zip : 28205-4644
Country : US
Telephone Number : 303-717-2006
Fax Number :
Provider Business Practice Location Address
First Line : 3705 LATROBE DR STE 340
Second Line :
City : CHARLOTTE
State : NC
Zip : 28211-4823
Country : US
Telephone Number : 704-364-3989
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/13/2011
Last Update Date : 02/17/2017

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