MEDICARE: KRISTEN TERRY

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	0904003627	VA

General Provider Information

NPI Number	:	1427235621
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KRISTEN TERRY

Provider Business Mailing Address
First Line	:	819 FULTON AVE
Second Line	:
City	:	FALLS CHURCH
State	:	VA
Zip	:	22046-3228
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	520 N WASHINGTON ST
Second Line	:	SUITE 101
City	:	FALLS CHURCH
State	:	VA
Zip	:	22046-3538
Country	:	US
Telephone Number	:	703-241-2664
Fax Number	:

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

Provider Enumeration Date	:	01/30/2008
Last Update Date	:	01/30/2008

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Directions to “ KRISTEN TERRY ” Practice Location

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