MEDICARE: MS. ELLEN LEA WARANCH MSW 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	0904002306	VA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	058166	OTHER	VA	BLUE CROSS

General Provider Information

NPI Number	:	1518992007
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. ELLEN LEA WARANCH MSW LCSW

Provider Business Mailing Address
First Line	:	5000 CORPORATE WOODS DR
Second Line	:	SUITE 400
City	:	VIRGINIA BEACH
State	:	VA
Zip	:	23462-4429
Country	:	US
Telephone Number	:	757-459-4640
Fax Number	:	757-459-4643

Provider Business Practice Location Address
First Line	:	5000 CORPORATE WOODS DR
Second Line	:	SUITE 400
City	:	VIRGINIA BEACH
State	:	VA
Zip	:	23462-4429
Country	:	US
Telephone Number	:	757-459-4640
Fax Number	:	757-459-4643

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

Provider Enumeration Date	:	07/12/2006
Last Update Date	:	06/17/2016

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