MEDICARE: MS. EILEEN GAIL IVEY M.S.W.

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	02540	MD

General Provider Information

NPI Number	:	1932113297
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. EILEEN GAIL IVEY M.S.W.

Provider Business Mailing Address
First Line	:	5480 WISCONSIN AVE
Second Line	:	SUITE 227
City	:	CHEVY CHASE
State	:	MD
Zip	:	20815-3530
Country	:	US
Telephone Number	:	301-652-1030
Fax Number	:	301-654-1929

Provider Business Practice Location Address
First Line	:	5480 WISCONSIN AVE
Second Line	:	SUITE 227
City	:	CHEVY CHASE
State	:	MD
Zip	:	20815-3530
Country	:	US
Telephone Number	:	301-652-1030
Fax Number	:	301-654-1929

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

Provider Enumeration Date	:	07/29/2006
Last Update Date	:	07/08/2007

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