MEDICARE: ERIN MCMENAMIN 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	0904010853	VA

General Provider Information

NPI Number	:	1003475575
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ERIN MCMENAMIN LCSW

Provider Business Mailing Address
First Line	:	2509 GEORGE MASON DR UNIT 6141
Second Line	:
City	:	VIRGINIA BEACH
State	:	VA
Zip	:	23456-1705
Country	:	US
Telephone Number	:	757-529-0099
Fax Number	:

Provider Business Practice Location Address
First Line	:	1909 SPLIT RAIL DR
Second Line	:
City	:	VIRGINIA BEACH
State	:	VA
Zip	:	23453-6614
Country	:	US
Telephone Number	:	215-480-8888
Fax Number	:

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

Provider Enumeration Date	:	06/10/2019
Last Update Date	:	06/10/2019

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