MEDICARE: ETHAN ULANOW LCSW-C

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

General Provider Information

NPI Number	:	1972094241
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ETHAN ULANOW LCSW-C

Provider Business Mailing Address
First Line	:	10305 SNOWPINE WAY
Second Line	:
City	:	POTOMAC
State	:	MD
Zip	:	20854-3940
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4405 E WEST HWY STE 601
Second Line	:
City	:	BETHESDA
State	:	MD
Zip	:	20814-4537
Country	:	US
Telephone Number	:	301-555-5555
Fax Number	:

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

Provider Enumeration Date	:	05/22/2018
Last Update Date	:	07/30/2024

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