MEDICARE: MRS. ELIZABETH HERION DEAL MSW, 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	1041C0700X	Clinical Social Worker	C000310	NC

General Provider Information

NPI Number	:	1710031695
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. ELIZABETH HERION DEAL MSW, LCSW

Provider Business Mailing Address
First Line	:	400 CRUTCHFIELD STREET
Second Line	:	SUITE C
City	:	DURHAM
State	:	NC
Zip	:	27704
Country	:	US
Telephone Number	:	919-471-6501
Fax Number	:	919-471-2211

Provider Business Practice Location Address
First Line	:	400 CRUTCHFIELD ST
Second Line	:	SUITE C
City	:	DURHAM
State	:	NC
Zip	:	27704-2771
Country	:	US
Telephone Number	:	919-471-6501
Fax Number	:	919-471-2211

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

Provider Enumeration Date	:	01/22/2007
Last Update Date	:	07/08/2007

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