MEDICARE: CARLA CARICK

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	0904010016	VA

General Provider Information

NPI Number	:	1730691056
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CARLA CARICK

Provider Business Mailing Address
First Line	:	1217 WEATHERSTONE CT
Second Line	:
City	:	RESTON
State	:	VA
Zip	:	20194-1349
Country	:	US
Telephone Number	:	215-490-2683
Fax Number	:

Provider Business Practice Location Address
First Line	:	133 PARK ST NE
Second Line	:
City	:	VIENNA
State	:	VA
Zip	:	22180-4666
Country	:	US
Telephone Number	:	703-281-2657
Fax Number	:

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

Provider Enumeration Date	:	10/26/2017
Last Update Date	:	10/26/2017

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Directions to “ CARLA CARICK ” Practice Location

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