MEDICARE: ANGELA LASTER 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	LC50078540	DC

General Provider Information

NPI Number	:	1407366172
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANGELA LASTER LCSW

Provider Business Mailing Address
First Line	:	1406 WINDJAMMER CT
Second Line	:
City	:	FORT WASHINGTON
State	:	MD
Zip	:	20744-2707
Country	:	US
Telephone Number	:	202-492-4944
Fax Number	:

Provider Business Practice Location Address
First Line	:	1406 WINDJAMMER CT.
Second Line	:
City	:	FORT WASHINGTON
State	:	MD
Zip	:	20744-2074
Country	:	US
Telephone Number	:	202-492-4944
Fax Number	:	202-492-4944

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

Provider Enumeration Date	:	10/06/2017
Last Update Date	:	10/06/2017

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