MEDICARE: MRS. DAMITKA BYNUM 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	0904009309	VA
2	1041C0700X	Clinical Social Worker

General Provider Information

NPI Number	:	1649661224
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. DAMITKA BYNUM MSW

Provider Business Mailing Address
First Line	:	5250 CHALLEDON DR
Second Line	:
City	:	VIRGINIA BEACH
State	:	VA
Zip	:	23462-6304
Country	:	US
Telephone Number	:	757-568-0006
Fax Number	:	757-301-5313

Provider Business Practice Location Address
First Line	:	5250 CHALLEDON DR
Second Line	:
City	:	VIRGINIA BEACH
State	:	VA
Zip	:	23462-6304
Country	:	US
Telephone Number	:	757-568-0006
Fax Number	:	757-301-5313

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

Provider Enumeration Date	:	02/18/2015
Last Update Date	:	03/18/2021

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