MEDICARE: BARBARA EVANS-KWAMLA 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	104100000X	Social Worker	0904008676	VA

General Provider Information

NPI Number	:	1649687898
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BARBARA EVANS-KWAMLA LCSW

Provider Business Mailing Address
First Line	:	1012 HULL ST
Second Line	:
City	:	RICHMOND
State	:	VA
Zip	:	23224-4072
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1012 HULL ST
Second Line	:
City	:	RICHMOND
State	:	VA
Zip	:	23224-4072
Country	:	US
Telephone Number	:	804-230-0999
Fax Number	:	804-230-0998

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

Provider Enumeration Date	:	07/21/2014
Last Update Date	:	07/21/2014

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