MEDICARE: MRS. CAROLYN SUSAN LEMPERT 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	090400940	VA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	090400940	OTHER	VA	LCSW
2	090400940	OTHER	VA	LICENSED CLINICAL SOCIAL WORKER

General Provider Information

NPI Number	:	1902333081
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. CAROLYN SUSAN LEMPERT LCSW

Provider Business Mailing Address
First Line	:	4609 MILES STANDISH RD
Second Line	:
City	:	VIRGINIA BEACH
State	:	VA
Zip	:	23455-4932
Country	:	US
Telephone Number	:	757-773-3649
Fax Number	:

Provider Business Practice Location Address
First Line	:	5000 CORPORATE WOODS DR STE 500
Second Line	:
City	:	VIRGINIA BEACH
State	:	VA
Zip	:	23462-4429
Country	:	US
Telephone Number	:	757-321-2242
Fax Number	:	757-321-2236

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

Provider Enumeration Date	:	05/19/2017
Last Update Date	:	05/19/2017

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