MEDICARE: MRS. ELAINE BARBARA BIRK 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	0904001628	VA

General Provider Information

NPI Number	:	1447233697
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. ELAINE BARBARA BIRK LCSW

Provider Business Mailing Address
First Line	:	1821 OLD DONATION PKWY
Second Line	:
City	:	VIRGINIA BEACH
State	:	VA
Zip	:	23454-3033
Country	:	US
Telephone Number	:	757-481-2669
Fax Number	:	757-481-4967

Provider Business Practice Location Address
First Line	:	1821 OLD DONATION PKWY
Second Line	:	SUITE 11
City	:	VIRGINIA BEACH
State	:	VA
Zip	:	23454-3033
Country	:	US
Telephone Number	:	757-481-2669
Fax Number	:	757-481-4967

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

Provider Enumeration Date	:	11/22/2005
Last Update Date	:	07/08/2007

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