MEDICARE: DR. NANCY H HENNINGSEN LCSWC

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	103T00000X	Psychologist	12280	MD

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	:	1619052818
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. NANCY H HENNINGSEN LCSWC

Provider Business Mailing Address
First Line	:	7108 ORKNEY PKWY
Second Line	:
City	:	BETHESDA
State	:	MD
Zip	:	20817-4918
Country	:	US
Telephone Number	:	301-320-3176
Fax Number	:

Provider Business Practice Location Address
First Line	:	8607 2ND AVE
Second Line	:	407A
City	:	SILVER SPRING
State	:	MD
Zip	:	20910-3355
Country	:	US
Telephone Number	:	301-661-4433
Fax Number	:	301-582-6461

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

Provider Enumeration Date	:	10/26/2006
Last Update Date	:	07/23/2012

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