MEDICARE: MRS. GERALDINE B POGUE 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		VA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1609974278
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. GERALDINE B POGUE LCSW

Provider Business Mailing Address
First Line	:	4721 TARPON LN
Second Line	:
City	:	ALEXANDRIA
State	:	VA
Zip	:	22309-3142
Country	:	US
Telephone Number	:	703-780-8737
Fax Number	:	703-780-3230

Provider Business Practice Location Address
First Line	:	6020 RICHMOND HWY STE 200
Second Line	:
City	:	ALEXANDRIA
State	:	VA
Zip	:	22303-2157
Country	:	US
Telephone Number	:	703-960-7261
Fax Number	:	703-780-3230

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

Provider Enumeration Date	:	09/20/2006
Last Update Date	:	07/26/2007

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