MEDICARE: VALERIE MCDONNELL

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	104100000X	Social Worker

General Provider Information

NPI Number	:	1114371572
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	VALERIE MCDONNELL

Provider Business Mailing Address
First Line	:	4325 ALLENBEND RD
Second Line	:
City	:	GLEN ALLEN
State	:	VA
Zip	:	23060-6519
Country	:	US
Telephone Number	:	804-873-5825
Fax Number	:

Provider Business Practice Location Address
First Line	:	7489 RIGHT FLANK RD
Second Line	:	STE 330
City	:	MECHANICSVILLE
State	:	VA
Zip	:	23116-3845
Country	:	US
Telephone Number	:	804-398-8401
Fax Number	:

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

Provider Enumeration Date	:	04/21/2016
Last Update Date	:	04/21/2016

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