MEDICARE: MS. TERRY LOUISE ULLMAN 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	1041C0700X	Clinical Social Worker	04653	MD
2	1041C0700X	Clinical Social Worker	LC302651	DC

General Provider Information

NPI Number	:	1801983804
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. TERRY LOUISE ULLMAN MSW

Provider Business Mailing Address
First Line	:	7126 DEER VALLEY RD
Second Line	:
City	:	HIGHLAND
State	:	MD
Zip	:	20777-9512
Country	:	US
Telephone Number	:	301-854-1121
Fax Number	:	301-854-2022

Provider Business Practice Location Address
First Line	:	4401 E WEST HWY
Second Line	:	SUITE 202
City	:	BETHESDA
State	:	MD
Zip	:	20814-4523
Country	:	US
Telephone Number	:	301-854-1121
Fax Number	:	301-854-2022

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

Provider Enumeration Date	:	10/10/2006
Last Update Date	:	07/08/2007

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