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General NPI Number Information
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NPI Number | 1184934242
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Entity Type | Organization
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Legal Business Name | SSHEWCHUK88
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Dates
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Enumeration Date | 10/07/2010
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Last Update Date | 10/07/2010
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Provider Practice Location Address
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Address Line | 7910 WOODMONT AVE SUITE 460
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City | BETHESDA
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State | MD
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Zip | 20814-3002
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Country | US
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Telephone | 301-656-9520
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Fax | 301-718-3633
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Provider Business Mailing Address
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Address Line | 7910 WOODMONT AVE SUITE 460
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City | BETHESDA
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State | MD
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Zip | 20814-3002
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Country | US
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Telephone | 301-656-9520
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Fax | 301-718-3633
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Authorized Official
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Title or Position | LCSW-C
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Name | SUSAN SHEWCHUK
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Credential | MSW
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Telephone | 301-656-9520
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 11612
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License Number State | MD
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