MEDICARE: CAROLINE MCCARD THERAPY, LLC

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	1041C0700X	Clinical Social Worker

General Provider Information

NPI Number	:	1700636420
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CAROLINE MCCARD THERAPY, LLC

Provider Business Mailing Address
First Line	:	5838 BLACKSHIRE PATH
Second Line	:
City	:	INVER GROVE HEIGHTS
State	:	MN
Zip	:	55076-1859
Country	:	US
Telephone Number	:	612-234-2770
Fax Number	:

Provider Business Practice Location Address
First Line	:	5838 BLACKSHIRE PATH
Second Line	:
City	:	INVER GROVE HEIGHTS
State	:	MN
Zip	:	55076-1859
Country	:	US
Telephone Number	:	612-234-2770
Fax Number	:

Authorized Official
Title or Position	:	OWNER/ PROVIDER
Name	:	CAROLINE MCCARD
Credential	:	LICSW
Telephone Number	:	612-234-2770

Provider Enumeration Date	:	03/25/2024
Last Update Date	:	03/25/2024

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