MEDICARE: MRS. BEVERLY Y. CHESTNUTT 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	0904000681	VA

General Provider Information

NPI Number	:	1598999120
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. BEVERLY Y. CHESTNUTT LCSW

Provider Business Mailing Address
First Line	:	131 HILL TOP RD
Second Line	:
City	:	CLARKSVILLE
State	:	VA
Zip	:	23927-3327
Country	:	US
Telephone Number	:	703-642-7238
Fax Number	:

Provider Business Practice Location Address
First Line	:	131 HILL TOP RD
Second Line	:
City	:	CLARKSVILLE
State	:	VA
Zip	:	23927-3327
Country	:	US
Telephone Number	:	434-374-8812
Fax Number	:

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

Provider Enumeration Date	:	05/11/2009
Last Update Date	:	06/15/2009

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