MEDICARE: LISA B SEDJAT 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	1041C0700X	Clinical Social Worker	0904002771	VA

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
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1407161565
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LISA B SEDJAT LCSW

Provider Business Mailing Address
First Line	:	2108 THOROUGHGOOD RD
Second Line	:
City	:	VIRGINIA BEACH
State	:	VA
Zip	:	23455-4015
Country	:	US
Telephone Number	:	757-416-5325
Fax Number	:	757-416-5326

Provider Business Practice Location Address
First Line	:	2108 THOROUGHGOOD RD
Second Line	:
City	:	VIRGINIA BEACH
State	:	VA
Zip	:	23455-4015
Country	:	US
Telephone Number	:	757-416-5325
Fax Number	:	757-416-5326

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

Provider Enumeration Date	:	08/13/2010
Last Update Date	:	08/13/2010

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