MEDICARE: LAUREN NICOLE MCDONOUGH MSW, 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	0904010064	VA

General Provider Information

NPI Number	:	1659897882
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LAUREN NICOLE MCDONOUGH MSW, LCSW

Provider Business Mailing Address
First Line	:	1678 WAINWRIGHT DR
Second Line	:
City	:	RESTON
State	:	VA
Zip	:	20190-3433
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	133 PARK ST NE
Second Line	:
City	:	VIENNA
State	:	VA
Zip	:	22180-4666
Country	:	US
Telephone Number	:	571-308-3583
Fax Number	:	571-308-3583

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

Provider Enumeration Date	:	08/18/2017
Last Update Date	:	03/17/2018

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