MEDICARE: HALLEY M CARMACK 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	C008379	NC
2	1041C0700X	Clinical Social Worker	SW16627	FL

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	:	1932472685
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HALLEY M CARMACK LCSW

Provider Business Mailing Address
First Line	:	1 TROPICAL DR APT 5
Second Line	:
City	:	OCEAN RIDGE
State	:	FL
Zip	:	33435-7030
Country	:	US
Telephone Number	:	209-573-0235
Fax Number	:

Provider Business Practice Location Address
First Line	:	550 SE 6TH AVE STE 200E
Second Line	:
City	:	DELRAY BEACH
State	:	FL
Zip	:	33483-5306
Country	:	US
Telephone Number	:	561-501-0188
Fax Number	:

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

Provider Enumeration Date	:	02/10/2012
Last Update Date	:	04/05/2020

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