MEDICARE: MS. MARIA JANOSCHKA L.C.S.W.

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	0904003051	VA

General Provider Information

NPI Number	:	1306211461
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. MARIA JANOSCHKA L.C.S.W.

Provider Business Mailing Address
First Line	:	12601 AMERSHIRE CT
Second Line	:
City	:	GLEN ALLEN
State	:	VA
Zip	:	23059-6915
Country	:	US
Telephone Number	:	434-218-5510
Fax Number	:

Provider Business Practice Location Address
First Line	:	5230 HICKORY PARK DR
Second Line	:	SUITE A
City	:	GLEN ALLEN
State	:	VA
Zip	:	23059-2628
Country	:	US
Telephone Number	:	434-218-5510
Fax Number	:

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

Provider Enumeration Date	:	12/01/2015
Last Update Date	:	12/01/2015

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