MEDICARE: JENNIFER CANN, 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	0904006344	VA

General Provider Information

NPI Number	:	1629506035
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JENNIFER CANN, LCSW

Provider Business Mailing Address
First Line	:	8515 CYRUS PL
Second Line	:
City	:	ALEXANDRIA
State	:	VA
Zip	:	22308-2014
Country	:	US
Telephone Number	:	703-946-2032
Fax Number	:

Provider Business Practice Location Address
First Line	:	600 CAMERON ST STE 304
Second Line	:
City	:	ALEXANDRIA
State	:	VA
Zip	:	22314-2506
Country	:	US
Telephone Number	:	703-946-2032
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	JENNIFER CANN
Credential	:	LCSW
Telephone Number	:	703-946-2032

Provider Enumeration Date	:	05/30/2017
Last Update Date	:	05/30/2017

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