MEDICARE: ELIZABETH ANN BOSTICK 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	101YM0800X	Mental Health Counselor	0904003895	VA

General Provider Information

NPI Number	:	1295094118
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ELIZABETH ANN BOSTICK LCSW

Provider Business Mailing Address
First Line	:	600 CAMERON ST
Second Line	:
City	:	ALEXANDRIA
State	:	VA
Zip	:	22314-2506
Country	:	US
Telephone Number	:	703-216-8457
Fax Number	:	703-340-1642

Provider Business Practice Location Address
First Line	:	600 CAMERON ST
Second Line	:
City	:	ALEXANDRIA
State	:	VA
Zip	:	22314-2506
Country	:	US
Telephone Number	:	703-340-1600
Fax Number	:	703-340-1642

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

Provider Enumeration Date	:	05/12/2012
Last Update Date	:	06/13/2026

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