MEDICARE: MELISSA LIPPMAN KILBRIDE LCSW, LICSW, LCSW-C

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	LC50078577	DC
2	1041C0700X	Clinical Social Worker	149.012392	IL
3	1041C0700X	Clinical Social Worker	14350	MD
4	1041C0700X	Clinical Social Worker	0904006897	VA

General Provider Information

NPI Number	:	1528218070
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MELISSA LIPPMAN KILBRIDE LCSW, LICSW, LCSW-C

Provider Business Mailing Address
First Line	:	1425 11TH ST NW
Second Line	:	UNIT 204
City	:	WASHINGTON
State	:	DC
Zip	:	20001-3302
Country	:	US
Telephone Number	:	773-263-0536
Fax Number	:

Provider Business Practice Location Address
First Line	:	64 NEW YORK AVE NE
Second Line	:	4TH FLOOR
City	:	WASHINGTON
State	:	DC
Zip	:	20002-3320
Country	:	US
Telephone Number	:	773-263-0436
Fax Number	:

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

Provider Enumeration Date	:	09/22/2008
Last Update Date	:	10/24/2008

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