MEDICARE: KARRAH S FORT 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	SW16702	FL

General Provider Information

NPI Number	:	1770009581
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KARRAH S FORT MSW, LCSW

Provider Business Mailing Address
First Line	:	PO BOX 120965
Second Line	:
City	:	FORT LAUDERDALE
State	:	FL
Zip	:	33312-0007
Country	:	US
Telephone Number	:	954-372-6958
Fax Number	:

Provider Business Practice Location Address
First Line	:	535 NW 29TH TER
Second Line	:
City	:	FORT LAUDERDALE
State	:	FL
Zip	:	33311-7637
Country	:	US
Telephone Number	:	954-372-6958
Fax Number	:

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

Provider Enumeration Date	:	08/15/2017
Last Update Date	:	07/09/2024

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