MEDICARE: MRS. JANUARY S GEDAMU 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	0904006488	VA

General Provider Information

NPI Number	:	1699942326
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. JANUARY S GEDAMU LCSW

Provider Business Mailing Address
First Line	:	324 N FAIRFAX ST STE 200
Second Line	:
City	:	ALEXANDRIA
State	:	VA
Zip	:	22314-2625
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	324 N FAIRFAX ST STE 200
Second Line	:
City	:	ALEXANDRIA
State	:	VA
Zip	:	22314-2625
Country	:	US
Telephone Number	:	804-270-1124
Fax Number	:	804-270-2070

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

Provider Enumeration Date	:	05/12/2008
Last Update Date	:	03/01/2019

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