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General NPI Number Information
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NPI Number | 1275688103
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Entity Type | Individual
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Provider Name | LYNE TAYLOR GENSER MSW,LCSW
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Gender | Male
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Dates
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Enumeration Date | 01/23/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 5614 SHIELDS DR WYNGATE MEDICAL PARK
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City | BETHESDA
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State | MD
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Zip | 20817-3532
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Country | US
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Telephone | 703-550-4806
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Fax | 703-931-1931
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Provider Business Mailing Address
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Address Line | 8905 WANDERING TRAIL DR
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City | POTOMAC
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State | MD
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Zip | 20854-2379
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Country | US
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Telephone | 703-550-4806
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Fax | 703-931-1931
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | 3903
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License Number State | MD
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 550
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License Number State | VA
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