MEDICARE: MS. SHIRLEY ANN MYERS

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	LC303483	DC
2	1041C0700X	Clinical Social Worker	13413	MD

General Provider Information

NPI Number	:	1487957221
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. SHIRLEY ANN MYERS

Provider Business Mailing Address
First Line	:	9806 BROADMOOR TER
Second Line	:
City	:	UPPER MARLBORO
State	:	MD
Zip	:	20772-5358
Country	:	US
Telephone Number	:	301-856-0888
Fax Number	:	301-877-1245

Provider Business Practice Location Address
First Line	:	7010 LITTLE RIVER TPKE STE 335
Second Line	:
City	:	ANNANDALE
State	:	VA
Zip	:	22003-3249
Country	:	US
Telephone Number	:	703-813-0156
Fax Number	:

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

Provider Enumeration Date	:	12/17/2010
Last Update Date	:	12/17/2010

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