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NPI Code Detail

MEDICARE: JUDITH HOGE MINTER LCSW

MEDICARE:   JUDITH HOGE MINTER  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
1104100000XSocial Worker0904001192VA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1249190OTHERVAANTHEM INS

General Provider Information

NPI Number : 1538387097
Entity Type Code : Individual
Provider Name (Legal Business Name) : JUDITH HOGE MINTER LCSW
Provider Business Mailing Address
First Line : 100 EAST SOUTH ST
Second Line : STE 5
City : CHARLOTTESVILLE
State : VA
Zip : 22902-5217
Country : US
Telephone Number : 434-971-4747
Fax Number : 434-293-4690
Provider Business Practice Location Address
First Line : 100 EAST SOUTH ST
Second Line : STE 5
City : CHARLOTTESVILLE
State : VA
Zip : 22902-5217
Country : US
Telephone Number : 434-971-4747
Fax Number : 434-293-4690
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/23/2007
Last Update Date : 07/08/2007

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Directions to “ JUDITH HOGE MINTER LCSW” Practice Location

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