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NPI Code Detail

MEDICARE: LOURDES SAN PEDRO LCSW

MEDICARE: LOURDES SAN PEDRO 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
11041C0700XClinical Social Worker

General Provider Information

NPI Number : 1225385776
Entity Type Code : Individual
Provider Name (Legal Business Name) : LOURDES SAN PEDRO LCSW
Provider Business Mailing Address
First Line : 5707 LAWSONS HILL CT
Second Line :
City : ALEXANDRIA
State : VA
Zip : 22310-2331
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 2800 EISENHOWER AVE STE 220
Second Line :
City : ALEXANDRIA
State : VA
Zip : 22314-4587
Country : US
Telephone Number : 703-424-9550
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/14/2012
Last Update Date : 09/30/2022

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Directions to “ LOURDES SAN PEDRO LCSW” Practice Location

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