MEDICARE: MS. DEBORAH MARIE BUMBAUGH 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	0904008121	VA

General Provider Information

NPI Number	:	1336566777
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. DEBORAH MARIE BUMBAUGH LCSW

Provider Business Mailing Address
First Line	:	6624 COLTON CRAWFORD CIR APT 305
Second Line	:
City	:	FALLS CHURCH
State	:	VA
Zip	:	22042-6655
Country	:	US
Telephone Number	:	410-960-8833
Fax Number	:

Provider Business Practice Location Address
First Line	:	3120 FAIRVIEW PARK DR STE 240
Second Line	:
City	:	FALLS CHURCH
State	:	VA
Zip	:	22042-4569
Country	:	US
Telephone Number	:	703-228-1600
Fax Number	:	703-228-1117

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

Provider Enumeration Date	:	03/24/2014
Last Update Date	:	10/13/2023

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