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NPI Code Detail

MEDICARE: LARA BURT

MEDICARE: LARA BURT
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
11041S0200XSchool Social WorkerLG50082647DC

General Provider Information

NPI Number : 1407400153
Entity Type Code : Individual
Provider Name (Legal Business Name) : LARA BURT
Provider Business Mailing Address
First Line : 1801 MISSISSIPPI AVE SE FL 3
Second Line :
City : WASHINGTON
State : DC
Zip : 20020-6120
Country : US
Telephone Number : 847-644-4987
Fax Number :
Provider Business Practice Location Address
First Line : 1801 MISSISSIPPI AVE SE FL 3
Second Line :
City : WASHINGTON
State : DC
Zip : 20020-6120
Country : US
Telephone Number : 847-644-4987
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/31/2019
Last Update Date : 07/31/2019

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Directions to “ LARA BURT ” Practice Location

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