MEDICARE: MRS. AMANDA S CHESNEY MSW, 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	LC50078564	DC
2	1041C0700X	Clinical Social Worker	149.012542	IL

General Provider Information

NPI Number	:	1245471242
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. AMANDA S CHESNEY MSW, LICSW

Provider Business Mailing Address
First Line	:	64 NEW YORK AVE NE
Second Line	:
City	:	WASHINGTON
State	:	DC
Zip	:	20002-3320
Country	:	US
Telephone Number	:	202-673-7051
Fax Number	:	202-673-7502

Provider Business Practice Location Address
First Line	:	1346 FLORIDA AVE NW
Second Line	:
City	:	WASHINGTON
State	:	DC
Zip	:	20009-4838
Country	:	US
Telephone Number	:	202-232-6090
Fax Number	:	202-232-6282

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

Provider Enumeration Date	:	03/20/2009
Last Update Date	:	11/03/2011

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