MEDICARE: MR. DAVID ANDREW BENJAMIN 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	0904002646	VA

General Provider Information

NPI Number	:	1649373937
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. DAVID ANDREW BENJAMIN LCSW

Provider Business Mailing Address
First Line	:	8350 RICHMOND HWY
Second Line	:
City	:	ALEXANDRIA
State	:	VA
Zip	:	22309-2300
Country	:	US
Telephone Number	:	703-704-6858
Fax Number	:	703-704-6687

Provider Business Practice Location Address
First Line	:	8350 RICHMOND HWY
Second Line	:
City	:	ALEXANDRIA
State	:	VA
Zip	:	22309-2300
Country	:	US
Telephone Number	:	703-704-6858
Fax Number	:	703-704-6687

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

Provider Enumeration Date	:	09/06/2006
Last Update Date	:	07/08/2007

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