MEDICARE: BELLISA REICHELT MSW, LMSW, QMHP-A

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	171M00000X	Case Manager/Care Coordinator
2	104100000X	Social Worker

General Provider Information

NPI Number	:	1053686923
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BELLISA REICHELT MSW, LMSW, QMHP-A

Provider Business Mailing Address
First Line	:	3900 FAIRFAX DR UNIT 1613
Second Line	:
City	:	ARLINGTON
State	:	VA
Zip	:	22203-1690
Country	:	US
Telephone Number	:	703-814-6117
Fax Number	:

Provider Business Practice Location Address
First Line	:	3900 FAIRFAX DR UNIT 1613
Second Line	:
City	:	ARLINGTON
State	:	VA
Zip	:	22203-1690
Country	:	US
Telephone Number	:	703-814-6117
Fax Number	:

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

Provider Enumeration Date	:	03/12/2012
Last Update Date	:	08/19/2019

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