MEDICARE: MR. JOHN RICHARD DECARLIS LCSW-C

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	13115	MD
2	1041C0700X	Clinical Social Worker	2010038259	MO

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1710172457
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. JOHN RICHARD DECARLIS LCSW-C

Provider Business Mailing Address
First Line	:	10411 W 145TH TER
Second Line	:
City	:	OVERLAND PARK
State	:	KS
Zip	:	66221-2550
Country	:	US
Telephone Number	:	913-499-8096
Fax Number	:

Provider Business Practice Location Address
First Line	:	10411 W 145TH TER
Second Line	:
City	:	OVERLAND PARK
State	:	KS
Zip	:	66221-2550
Country	:	US
Telephone Number	:	913-499-8096
Fax Number	:

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

Provider Enumeration Date	:	09/06/2007
Last Update Date	:	03/01/2011

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