Individual provider Active NPI

Marilyn Moorer Raines, LCSW

  • Clinical Social Worker
  • Charlotte, NC
National Provider Identifier
1407994841
Registry record updated Jul 9, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
C000579 Issued in NC
Practice address
1505 E 4TH St
Charlotte, NC 28204-3223
Phone
(704) 905-9731
NPI assigned
Feb 1, 2007
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 9, 2007

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Social Worker 1041C0700X C000579 NC Primary

Addresses

Primary practice location

1505 E 4TH St
Charlotte, NC 28204-3223

Mailing address

6515 Barry Whitaker Rd
Charlotte, NC 28227-0414
Phone (704) 573-8984

Other identifiers 1

IdentifierTypeStateIssuer
6003073MedicaidNC

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1170288000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183939200000",
    "number": "1407994841",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6515 BARRY WHITAKER RD",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282270414",
            "telephone_number": "704-573-8984"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1505 E 4TH ST",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282043223",
            "telephone_number": "704-905-9731"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RAINES",
        "first_name": "MARILYN",
        "middle_name": "MOORER",
        "name_prefix": "Mrs.",
        "credential": "LCSW",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2007-02-01",
        "last_updated": "2007-07-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "NC",
            "license": "C000579",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "6003073",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Charlotte, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 9, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.