MEDICARE: MRS. SHERI ANN PHUONG 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	0904008591	VA

General Provider Information

NPI Number	:	1588076111
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. SHERI ANN PHUONG LCSW

Provider Business Mailing Address
First Line	:	7489 RIGHT FLANK RD
Second Line	:	330
City	:	MECHANICSVILLE
State	:	VA
Zip	:	23116-3845
Country	:	US
Telephone Number	:	804-723-6190
Fax Number	:

Provider Business Practice Location Address
First Line	:	7489 RIGHT FLANK RD
Second Line	:	330
City	:	MECHANICSVILLE
State	:	VA
Zip	:	23116-3845
Country	:	US
Telephone Number	:	804-723-6190
Fax Number	:

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

Provider Enumeration Date	:	06/02/2014
Last Update Date	:	09/23/2015

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