MEDICARE: MS. CARLA M HALL LICSW

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	LC50078690	DC

General Provider Information

NPI Number	:	1770638223
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. CARLA M HALL LICSW

Provider Business Mailing Address
First Line	:	632 E CAPITOL ST NE APT 6
Second Line	:
City	:	WASHINGTON
State	:	DC
Zip	:	20003-1243
Country	:	US
Telephone Number	:	120-271-6660
Fax Number	:

Provider Business Practice Location Address
First Line	:	632 E CAPITOL ST NE APT 6
Second Line	:
City	:	WASHINGTON
State	:	DC
Zip	:	20003-1243
Country	:	US
Telephone Number	:	120-271-6660
Fax Number	:

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

Provider Enumeration Date	:	01/24/2007
Last Update Date	:	12/30/2022

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