MEDICARE: ANNA M KRICHINSKY L.C.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	LSW0000003654	TN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	LSW0000003654	OTHER	TN	CLINICAL SOCIAL WORKER

General Provider Information

NPI Number	:	1023074994
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANNA M KRICHINSKY L.C.S.W.

Provider Business Mailing Address
First Line	:	4639 NEWCOM AVE
Second Line	:
City	:	KNOXVILLE
State	:	TN
Zip	:	37919-5131
Country	:	US
Telephone Number	:	865-588-9766
Fax Number	:	865-588-1476

Provider Business Practice Location Address
First Line	:	4639 NEWCOM AVE
Second Line	:
City	:	KNOXVILLE
State	:	TN
Zip	:	37919-5131
Country	:	US
Telephone Number	:	865-588-9766
Fax Number	:	865-588-1476

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

Provider Enumeration Date	:	04/21/2006
Last Update Date	:	07/08/2007

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