MEDICARE: MS. SANDRA GOODBODY MSW

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	LC00300126	DC

General Provider Information

NPI Number	:	1316079288
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. SANDRA GOODBODY MSW

Provider Business Mailing Address
First Line	:	1400 20TH ST NW
Second Line	:	SUITE 103
City	:	WASHINGTON
State	:	DC
Zip	:	20036-5906
Country	:	US
Telephone Number	:	202-833-3070
Fax Number	:

Provider Business Practice Location Address
First Line	:	1400 20TH ST NW
Second Line	:	SUITE 103
City	:	WASHINGTON
State	:	DC
Zip	:	20036-5906
Country	:	US
Telephone Number	:	202-833-3070
Fax Number	:

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

Provider Enumeration Date	:	03/09/2007
Last Update Date	:	07/08/2007

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