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NPI Code Detail

MEDICARE: DR. CAROL LYNN ANDERSON ACSW, LMSW, CAAC

MEDICARE: DR. CAROL LYNN ANDERSON ACSW, LMSW, CAAC
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
11041C0700XClinical Social Worker6801065696MI

General Provider Information

NPI Number : 1750612776
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. CAROL LYNN ANDERSON ACSW, LMSW, CAAC
Provider Business Mailing Address
First Line : 940 E 8TH ST
Second Line :
City : TRAVERSE CITY
State : MI
Zip : 49686-2893
Country : US
Telephone Number : 231-922-4810
Fax Number : 231-922-4884
Provider Business Practice Location Address
First Line : 940 E 8TH ST
Second Line :
City : TRAVERSE CITY
State : MI
Zip : 49686-2893
Country : US
Telephone Number : 231-922-4810
Fax Number : 231-922-4884
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/15/2010
Last Update Date : 01/15/2010

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