MEDICARE: KATHARINE ANNE HODGSON 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	0904010038	VA

General Provider Information

NPI Number	:	1154830040
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KATHARINE ANNE HODGSON LCSW

Provider Business Mailing Address
First Line	:	2104 MOUNT VERNON AVE
Second Line	:
City	:	ALEXANDRIA
State	:	VA
Zip	:	22301-1312
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2104 MOUNT VERNON AVE
Second Line	:
City	:	ALEXANDRIA
State	:	VA
Zip	:	22301-1312
Country	:	US
Telephone Number	:	703-346-1542
Fax Number	:

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

Provider Enumeration Date	:	09/24/2017
Last Update Date	:	09/24/2017

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