MEDICARE: AMBER JUNE LCSW, MAC

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	0904008478	VA

General Provider Information

NPI Number	:	1184126161
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AMBER JUNE LCSW, MAC

Provider Business Mailing Address
First Line	:	PO BOX 2736
Second Line	:
City	:	ASHBURN
State	:	VA
Zip	:	20146-2736
Country	:	US
Telephone Number	:	703-581-7729
Fax Number	:

Provider Business Practice Location Address
First Line	:	11870 SUNRISE VALLEY DR STE 200
Second Line	:
City	:	RESTON
State	:	VA
Zip	:	20191-3303
Country	:	US
Telephone Number	:	703-581-7729
Fax Number	:

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

Provider Enumeration Date	:	03/06/2018
Last Update Date	:	03/06/2018

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