MEDICARE: MR. WINSTON M. CLARKE LICSW

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	1041S0200X	School Social Worker		DC

General Provider Information

NPI Number	:	1902233018
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. WINSTON M. CLARKE LICSW

Provider Business Mailing Address
First Line	:	5680 STEVENS FOREST RD
Second Line	:	APT. 56
City	:	COLUMBIA
State	:	MD
Zip	:	21045-3371
Country	:	US
Telephone Number	:	301-814-2816
Fax Number	:

Provider Business Practice Location Address
First Line	:	5680 STEVENS FOREST RD
Second Line	:	APT. 56
City	:	COLUMBIA
State	:	MD
Zip	:	21045-3371
Country	:	US
Telephone Number	:	301-814-2816
Fax Number	:

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

Provider Enumeration Date	:	10/03/2013
Last Update Date	:	10/03/2013

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