MEDICARE: CRYSTAL D CARTER 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	7442-123	WI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1902041148
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CRYSTAL D CARTER MSW, LCSW

Provider Business Mailing Address
First Line	:	620 S 76TH ST
Second Line	:	SUITE 120
City	:	MILWAUKEE
State	:	WI
Zip	:	53214-1549
Country	:	US
Telephone Number	:	414-453-1400
Fax Number	:	414-453-3389

Provider Business Practice Location Address
First Line	:	620 S 76TH ST
Second Line	:	SUITE 120
City	:	MILWAUKEE
State	:	WI
Zip	:	53214-1549
Country	:	US
Telephone Number	:	414-453-1400
Fax Number	:	414-453-3389

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

Provider Enumeration Date	:	12/02/2008
Last Update Date	:	12/02/2008

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