MEDICARE: MEGAN MUNZERT LICSW

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	LG50080823	DC
2	1041C0700X	Clinical Social Worker	LC50081280	DC

General Provider Information

NPI Number	:	1457809568
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MEGAN MUNZERT LICSW

Provider Business Mailing Address
First Line	:	1736 18TH ST NW
Second Line	:	105
City	:	WASHINGTON
State	:	DC
Zip	:	20009-6150
Country	:	US
Telephone Number	:	202-643-7013
Fax Number	:

Provider Business Practice Location Address
First Line	:	1736 18TH ST NW
Second Line	:	105
City	:	WASHINGTON
State	:	DC
Zip	:	20009-6150
Country	:	US
Telephone Number	:	202-643-7013
Fax Number	:

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

Provider Enumeration Date	:	09/18/2016
Last Update Date	:	07/10/2017

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