MEDICARE: JAN L WATKINS 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	LC50079206	DC
2	1041C0700X	Clinical Social Worker	0904007670	VA

General Provider Information

NPI Number	:	1538508353
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JAN L WATKINS LCSW

Provider Business Mailing Address
First Line	:	407 N LEE ST
Second Line	:
City	:	ALEXANDRIA
State	:	VA
Zip	:	22314-2301
Country	:	US
Telephone Number	:	703-408-0091
Fax Number	:

Provider Business Practice Location Address
First Line	:	505 WYTHE ST
Second Line	:
City	:	ALEXANDRIA
State	:	VA
Zip	:	22314-1917
Country	:	US
Telephone Number	:	571-305-2320
Fax Number	:

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

Provider Enumeration Date	:	06/14/2013
Last Update Date	:	04/21/2017

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