MEDICARE: KRISTIN JAUNDRILL LMSW

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	1671	NH
2	104100000X	Social Worker	CW018095	PA

General Provider Information

NPI Number	:	1609025683
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KRISTIN JAUNDRILL LMSW

Provider Business Mailing Address
First Line	:	1000 JEFFERSON ST.
Second Line	:	STE. 2C
City	:	LYNCHBURG
State	:	VA
Zip	:	24504
Country	:	US
Telephone Number	:	617-375-0496
Fax Number	:	617-807-0958

Provider Business Practice Location Address
First Line	:	1800 JFK BLVD.
Second Line	:	STE. 1404
City	:	PHILADELPHIA
State	:	PA
Zip	:	19102
Country	:	US
Telephone Number	:	215-399-9764
Fax Number	:

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

Provider Enumeration Date	:	09/15/2008
Last Update Date	:	03/18/2015

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