MEDICARE: SYNAVIA GEORGE LCSW

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	LC50078806	DC

General Provider Information

NPI Number	:	1154705838
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SYNAVIA GEORGE LCSW

Provider Business Mailing Address
First Line	:	4413 BLUE CLAY RD
Second Line	:
City	:	CASTLE HAYNE
State	:	NC
Zip	:	28429-6122
Country	:	US
Telephone Number	:	202-247-0429
Fax Number	:

Provider Business Practice Location Address
First Line	:	4413 BLUE CLAY RD
Second Line	:
City	:	CASTLE HAYNE
State	:	NC
Zip	:	28429-6122
Country	:	US
Telephone Number	:	202-247-0429
Fax Number	:

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

Provider Enumeration Date	:	07/13/2015
Last Update Date	:	07/13/2015

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