=====================================================
General NPI Number Information
=====================================================
NPI Number | 1235402603
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ANN MARIE CASE LCSW
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/16/2012
-----------------------------------------------------
Last Update Date | 02/16/2012
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 9501 FARRELL RD
-----------------------------------------------------
City | FT BELVOIR
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 22060
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 703-805-0510
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 71 TRADEWINDS ROAD
-----------------------------------------------------
City | OAK BLUFFS
-----------------------------------------------------
State | MA
-----------------------------------------------------
Zip | 02557-0843
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 774-563-9176
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number | 214095
-----------------------------------------------------
License Number State | MA
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number | LG50079660
-----------------------------------------------------
License Number State | DC
-----------------------------------------------------