MEDICARE: JEANNETTE R ABELSON-GOODE LCSW, CSOTP

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	0904005346	VA
2	1041C0700X	Clinical Social Worker	0812000410	VA

General Provider Information

NPI Number	:	1356692388
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JEANNETTE R ABELSON-GOODE LCSW, CSOTP

Provider Business Mailing Address
First Line	:	703 N COURTHOUSE RD
Second Line	:	SUITE 101
City	:	NORTH CHESTERFIELD
State	:	VA
Zip	:	23236-4069
Country	:	US
Telephone Number	:	804-794-4482
Fax Number	:	804-379-7578

Provider Business Practice Location Address
First Line	:	703 N COURTHOUSE RD
Second Line	:	SUITE 101
City	:	NORTH CHESTERFIELD
State	:	VA
Zip	:	23236-4069
Country	:	US
Telephone Number	:	804-794-4482
Fax Number	:	804-379-7578

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

Provider Enumeration Date	:	10/01/2012
Last Update Date	:	10/01/2012

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