MEDICARE: COMMUNITY SERVICES AGENCY

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	302R00000X	Health Maintenance Organization	PRC790	DC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	PRC790	OTHER	DC	LICENSE PROFESSIONAL COUNSELOR

General Provider Information

NPI Number	:	1497902456
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COMMUNITY SERVICES AGENCY

Provider Business Mailing Address
First Line	:	3849 ALABAMA AVE SE
Second Line	:
City	:	WASHINGTON
State	:	DC
Zip	:	20020-1001
Country	:	US
Telephone Number	:	202-645-7251
Fax Number	:	202-645-7270

Provider Business Practice Location Address
First Line	:	3849 ALABAMA AVE SE
Second Line	:
City	:	WASHINGTON
State	:	DC
Zip	:	20020-1001
Country	:	US
Telephone Number	:	202-645-7251
Fax Number	:	202-645-7270

Authorized Official
Title or Position	:	ASSOCIATE DIRECTOR REIMBURSEMENT
Name	:	MS. REGINA SCOTT
Credential	:
Telephone Number	:	202-671-4001

Provider Enumeration Date	:	08/21/2008
Last Update Date	:	08/21/2008

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Directions to “COMMUNITY SERVICES AGENCY ” Practice Location

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