MEDICARE: AZALECH N/A TEGENE 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	101Y00000X	Counselor

General Provider Information

NPI Number	:	1629858865
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AZALECH N/A TEGENE MSW

Provider Business Mailing Address
First Line	:	1905 E ST SE # 14
Second Line	:
City	:	WASHINGTON
State	:	DC
Zip	:	20003-2593
Country	:	US
Telephone Number	:	202-673-9120
Fax Number	:

Provider Business Practice Location Address
First Line	:	64 NEW YORK AVE NE FL 3
Second Line	:
City	:	WASHINGTON
State	:	DC
Zip	:	20002-3328
Country	:	US
Telephone Number	:	202-673-9120
Fax Number	:

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

Provider Enumeration Date	:	10/04/2023
Last Update Date	:	10/04/2023

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