MEDICARE: MR. JON D. RAYLE 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	C007159	NC

General Provider Information

NPI Number	:	1932467958
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. JON D. RAYLE LCSW

Provider Business Mailing Address
First Line	:	3821 BISON HILL LN
Second Line	:
City	:	RALEIGH
State	:	NC
Zip	:	27604-5010
Country	:	US
Telephone Number	:	919-594-9662
Fax Number	:

Provider Business Practice Location Address
First Line	:	3821 BISON HILL LN
Second Line	:
City	:	RALEIGH
State	:	NC
Zip	:	27604-5010
Country	:	US
Telephone Number	:	919-594-9662
Fax Number	:

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

Provider Enumeration Date	:	04/27/2012
Last Update Date	:	11/06/2012

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