MEDICARE: MS. LENORA DEAS MSW

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	171M00000X	Case Manager/Care Coordinator

General Provider Information

NPI Number	:	1528581493
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. LENORA DEAS MSW

Provider Business Mailing Address
First Line	:	10418 GLEN OAKS DR
Second Line	:
City	:	CHESTER
State	:	VA
Zip	:	23831-1182
Country	:	US
Telephone Number	:	347-242-6358
Fax Number	:

Provider Business Practice Location Address
First Line	:	3524 BOULEVARD
Second Line	:
City	:	COLONIAL HGTS
State	:	VA
Zip	:	23834-1320
Country	:	US
Telephone Number	:	347-242-6358
Fax Number	:

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

Provider Enumeration Date	:	07/21/2017
Last Update Date	:	07/21/2017

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