MEDICARE: MR. KENNETH RICHARD THAU M.S.W., J.D.

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	0904003262	VA

General Provider Information

NPI Number	:	1013980523
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. KENNETH RICHARD THAU M.S.W., J.D.

Provider Business Mailing Address
First Line	:	PO BOX 807
Second Line	:
City	:	BRISTOW
State	:	VA
Zip	:	20136-0807
Country	:	US
Telephone Number	:	202-320-5322
Fax Number	:

Provider Business Practice Location Address
First Line	:	7969 SEQUOIA PARK WAY
Second Line	:
City	:	BRISTOW
State	:	VA
Zip	:	20136-1286
Country	:	US
Telephone Number	:	202-320-5322
Fax Number	:

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

Provider Enumeration Date	:	02/08/2006
Last Update Date	:	02/04/2025

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