MEDICARE: MRS. MARJORY SPENCER FRANKLIN MA

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	103TS0200X	School Psychologist	PPS-122403	VA
2	103TS0200X	School Psychologist	0831000969	VA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0813000969	OTHER	VA	VA DEPT HEALTH PROFESSIONS LICENSE

General Provider Information

NPI Number	:	1114411469
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. MARJORY SPENCER FRANKLIN MA

Provider Business Mailing Address
First Line	:	2110 WASHINGTON BLVD
Second Line	:
City	:	ARLINGTON
State	:	VA
Zip	:	22204-5719
Country	:	US
Telephone Number	:	703-228-6061
Fax Number	:

Provider Business Practice Location Address
First Line	:	855 N EDISON ST
Second Line	:
City	:	ARLINGTON
State	:	VA
Zip	:	22205-1209
Country	:	US
Telephone Number	:	703-228-2063
Fax Number	:

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

Provider Enumeration Date	:	06/20/2018
Last Update Date	:	06/20/2018

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