MEDICARE: MS. BENILDA N SHAHEED LCSW-C, LICSW

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	LC302652	DC
2	1041C0700X	Clinical Social Worker	10169	MD
3	1041C0700X	Clinical Social Worker	0904004040	VA

General Provider Information

NPI Number	:	1609944032
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. BENILDA N SHAHEED LCSW-C, LICSW

Provider Business Mailing Address
First Line	:	2101 EAST JEFFERSON STREET PPQA MEDICARE COMPLIANCE UNI
Second Line	:	KAISER PERMANENTE MID ATLANTIC PERMANENTE MEDICAL GROUP
City	:	ROCKVILLE
State	:	MD
Zip	:	20852-4908
Country	:	US
Telephone Number	:	301-816-2424
Fax Number	:

Provider Business Practice Location Address
First Line	:	5100 AUTH WAY
Second Line	:
City	:	SUITLAND
State	:	MD
Zip	:	20746-4207
Country	:	US
Telephone Number	:	301-702-5084
Fax Number	:

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

Provider Enumeration Date	:	12/01/2006
Last Update Date	:	02/09/2012

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