MEDICARE: NINA LOVELACE MSW, LMSW

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	104100000X	Social Worker	21602	MD

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	NA	OTHER		NA

General Provider Information

NPI Number	:	1427616598
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NINA LOVELACE MSW, LMSW

Provider Business Mailing Address
First Line	:	31 BOOTH ST UNIT 255
Second Line	:
City	:	GAITHERSBURG
State	:	MD
Zip	:	20878-6591
Country	:	US
Telephone Number	:	240-375-6530
Fax Number	:

Provider Business Practice Location Address
First Line	:	7003 PINEY BRANCH RD NW
Second Line	:
City	:	WASHINGTON
State	:	DC
Zip	:	20012-2417
Country	:	US
Telephone Number	:	240-375-6530
Fax Number	:

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

Provider Enumeration Date	:	06/03/2019
Last Update Date	:	06/03/2019

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