MEDICARE: RAYLENE HESSELBERG 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	171M00000X	Case Manager/Care Coordinator
2	1041C0700X	Clinical Social Worker	LC50078573	DC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1386836047
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RAYLENE HESSELBERG LICSW

Provider Business Mailing Address
First Line	:	1220 12TH ST SE
Second Line	:	SUITE 120
City	:	WASHINGTON
State	:	DC
Zip	:	20003-3733
Country	:	US
Telephone Number	:	202-715-7900
Fax Number	:	202-544-3783

Provider Business Practice Location Address
First Line	:	3020 14TH ST NW
Second Line	:
City	:	WASHINGTON
State	:	DC
Zip	:	20010-4336
Country	:	US
Telephone Number	:	202-745-4300
Fax Number	:	202-232-0723

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

Provider Enumeration Date	:	08/15/2007
Last Update Date	:	08/10/2010

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