MEDICARE: MISS LORRAINE NONE WASHINGTON LSWA

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	LA114	DC

General Provider Information

NPI Number	:	1497720031
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MISS LORRAINE NONE WASHINGTON LSWA

Provider Business Mailing Address
First Line	:	6700 LAKE PARK DR
Second Line	:	102
City	:	GREENBELT
State	:	MD
Zip	:	20770-3071
Country	:	US
Telephone Number	:	202-939-7634
Fax Number	:	202-939-7659

Provider Business Practice Location Address
First Line	:	1407 S ST NW
Second Line	:
City	:	WASHINGTON
State	:	DC
Zip	:	20009-3819
Country	:	US
Telephone Number	:	202-797-4425
Fax Number	:	202-797-4426

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

Provider Enumeration Date	:	02/17/2006
Last Update Date	:	07/08/2007

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