MEDICARE: CISTY JANE KARACIA MSSW, LISW

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	I-0006057	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	000000019121	OTHER	OH	ANTHEM
2	NK728	OTHER	OH	EMPIRE BC/BS
3	000000019121	OTHER	OH	ANTHEM BENEFIT ADMINISTRA
4	6274245	OTHER	OH	UNITEDBEHAVIORALHEALTH
5	6280813	OTHER	OH	UNITEDHEALTHCARE
6	3114096635001	OTHER	OH	TRIGON BC/BS
7	D6057M	OTHER	OH	TRIHEALTH CLAIMS ADMINIST
8	115663	OTHER	OH	COMPSYCH
9	4388674	OTHER	OH	AETNA
10	246674	OTHER	OH	MHN
11	9412949	OTHER	OH	PHCS

General Provider Information

NPI Number	:	1871505115
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CISTY JANE KARACIA MSSW, LISW

Provider Business Mailing Address
First Line	:	23 IRONGATE PARK DR
Second Line	:
City	:	CENTERVILLE FINANCE
State	:	OH
Zip	:	45459-4616
Country	:	US
Telephone Number	:	937-436-1600
Fax Number	:	937-436-2467

Provider Business Practice Location Address
First Line	:	23 IRONGATE PARK DR
Second Line	:
City	:	CENTERVILLE FINANCE
State	:	OH
Zip	:	45459-4616
Country	:	US
Telephone Number	:	937-436-1600
Fax Number	:	937-436-2467

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

Provider Enumeration Date	:	08/13/2006
Last Update Date	:	07/08/2007

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