MEDICARE: DORCAS WORLEY LUSHETSKY 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	0904006934	VA
2	1041C0700X	Clinical Social Worker	R059657-1	NY

General Provider Information

NPI Number	:	1750492344
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DORCAS WORLEY LUSHETSKY LCSW

Provider Business Mailing Address
First Line	:	6706 HAYCOCK RD
Second Line	:
City	:	FALLS CHURCH
State	:	VA
Zip	:	22043-1730
Country	:	US
Telephone Number	:	703-307-8359
Fax Number	:

Provider Business Practice Location Address
First Line	:	1485 CHAIN BRIDGE RD
Second Line	:	SUITE 203
City	:	MC LEAN
State	:	VA
Zip	:	22101-4501
Country	:	US
Telephone Number	:	703-307-8359
Fax Number	:

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

Provider Enumeration Date	:	08/31/2006
Last Update Date	:	12/02/2009

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