MEDICARE: KATE MARIE BOUCEK LEWIS MSW

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	LC50078226	DC
2	1041C0700X	Clinical Social Worker	0904007743	VA

General Provider Information

NPI Number	:	1457385486
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KATE MARIE BOUCEK LEWIS MSW

Provider Business Mailing Address
First Line	:	6910 RICHMOND HWY STE 110
Second Line	:
City	:	ALEXANDRIA
State	:	VA
Zip	:	22306-1850
Country	:	US
Telephone Number	:	703-660-8108
Fax Number	:	703-768-0103

Provider Business Practice Location Address
First Line	:	6910 RICHMOND HWY STE 110
Second Line	:
City	:	ALEXANDRIA
State	:	VA
Zip	:	22306-1850
Country	:	US
Telephone Number	:	703-660-8108
Fax Number	:	703-768-0103

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

Provider Enumeration Date	:	07/10/2006
Last Update Date	:	04/18/2012

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