MEDICARE: MR. LAURENCE DALE SCHULMAN 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	C003155	NC

General Provider Information

NPI Number	:	1871672568
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. LAURENCE DALE SCHULMAN LCSW

Provider Business Mailing Address
First Line	:	1373 E MOREHEAD ST
Second Line	:	SUITE 202
City	:	CHARLOTTE
State	:	NC
Zip	:	28204
Country	:	US
Telephone Number	:	704-377-3813
Fax Number	:	704-377-6884

Provider Business Practice Location Address
First Line	:	1373 E MOREHEAD ST
Second Line	:	SUITE 202
City	:	CHARLOTTE
State	:	NC
Zip	:	28204
Country	:	US
Telephone Number	:	704-377-3813
Fax Number	:	704-377-6884

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

Provider Enumeration Date	:	11/03/2006
Last Update Date	:	07/08/2007

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