MEDICARE: MS. MARY JANE SHUSTER 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	0909004269	VA

General Provider Information

NPI Number	:	1184609364
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. MARY JANE SHUSTER LCSW

Provider Business Mailing Address
First Line	:	809 MAIN ST
Second Line	:	SUITE100
City	:	NEWPORT NEWS
State	:	VA
Zip	:	23605-1090
Country	:	US
Telephone Number	:	757-595-2727
Fax Number	:

Provider Business Practice Location Address
First Line	:	809 MAIN ST
Second Line	:	SUITE100
City	:	NEWPORT NEWS
State	:	VA
Zip	:	23605-1090
Country	:	US
Telephone Number	:	757-595-2727
Fax Number	:

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

Provider Enumeration Date	:	12/12/2005
Last Update Date	:	03/27/2008

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