MEDICARE: NATASHA EWA 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	0904010661	VA

General Provider Information

NPI Number	:	1417428285
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NATASHA EWA LCSW

Provider Business Mailing Address
First Line	:	4036 RAVINE GAP DR
Second Line	:
City	:	SUFFOLK
State	:	VA
Zip	:	23434-3050
Country	:	US
Telephone Number	:	757-942-2412
Fax Number	:

Provider Business Practice Location Address
First Line	:	820 GREENBRIER CIR STE 32
Second Line	:
City	:	CHESAPEAKE
State	:	VA
Zip	:	23320-2646
Country	:	US
Telephone Number	:	401-359-1739
Fax Number	:

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

Provider Enumeration Date	:	12/05/2018
Last Update Date	:	02/20/2020

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