MEDICARE: TINA CLAIRE SEIBERT MSW

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	C002840	NC

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	2850614A	OTHER	NC	MEDICARE PTAN

Other Identifiers

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

General Provider Information

NPI Number	:	1720182264
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TINA CLAIRE SEIBERT MSW

Provider Business Mailing Address
First Line	:	107 SUNNYBROOK RD
Second Line	:
City	:	RALEIGH
State	:	NC
Zip	:	27610-1827
Country	:	US
Telephone Number	:	919-250-1260
Fax Number	:	919-747-0551

Provider Business Practice Location Address
First Line	:	107 SUNNYBROOK RD
Second Line	:
City	:	RALEIGH
State	:	NC
Zip	:	27610-1827
Country	:	US
Telephone Number	:	919-250-1260
Fax Number	:	919-747-0551

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

Provider Enumeration Date	:	09/12/2006
Last Update Date	:	09/18/2012

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