MEDICARE: JANE C NOHAVA 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	104100000X	Social Worker	0904000395	VA

General Provider Information

NPI Number	:	1598742322
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JANE C NOHAVA LCSW

Provider Business Mailing Address
First Line	:	1709 COLLEY AVE
Second Line	:	SUITE 312
City	:	NORFOLK
State	:	VA
Zip	:	23517-1675
Country	:	US
Telephone Number	:	757-640-0400
Fax Number	:	757-640-0497

Provider Business Practice Location Address
First Line	:	1709 COLLEY AVE
Second Line	:	SUITE 312
City	:	NORFOLK
State	:	VA
Zip	:	23517-1675
Country	:	US
Telephone Number	:	757-640-0400
Fax Number	:	757-640-0497

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

Provider Enumeration Date	:	12/22/2005
Last Update Date	:	07/08/2007

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