MEDICARE: EMILY KIRBY BOLAND MSW

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	0904007460	VA

General Provider Information

NPI Number	:	1609177765
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EMILY KIRBY BOLAND MSW

Provider Business Mailing Address
First Line	:	114 W GREENWAY BLVD
Second Line	:
City	:	FALLS CHURCH
State	:	VA
Zip	:	22046-4005
Country	:	US
Telephone Number	:	703-300-3285
Fax Number	:

Provider Business Practice Location Address
First Line	:	1608 SPRING HILL RD
Second Line	:	SUITE 300
City	:	VIENNA
State	:	VA
Zip	:	22182-2241
Country	:	US
Telephone Number	:	703-831-8300
Fax Number	:

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

Provider Enumeration Date	:	11/05/2010
Last Update Date	:	11/05/2010

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