MEDICARE: JULIANA BOT SALAU LICSW

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	16602	MD
2	1041C0700X	Clinical Social Worker	LC50079975	DC

General Provider Information

NPI Number	:	1124660253
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JULIANA BOT SALAU LICSW

Provider Business Mailing Address
First Line	:	6572 ELDERBERRY CT
Second Line	:
City	:	ELKRIDGE
State	:	MD
Zip	:	21075-6485
Country	:	US
Telephone Number	:	301-437-0485
Fax Number	:

Provider Business Practice Location Address
First Line	:	2526 PENNSYLVANIA AVE SE
Second Line	:
City	:	WASHINGTON
State	:	DC
Zip	:	20020-6719
Country	:	US
Telephone Number	:	202-748-5641
Fax Number	:	202-748-5647

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

Provider Enumeration Date	:	10/09/2019
Last Update Date	:	10/09/2019

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