MEDICARE: MRS. JANE BANDLER LCPC

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	101YP2500X	Professional Counselor	LC1705	MD

General Provider Information

NPI Number	:	1669405353
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. JANE BANDLER LCPC

Provider Business Mailing Address
First Line	:	5624 GREENTREE RD
Second Line	:
City	:	BETHESDA
State	:	MD
Zip	:	20817-3550
Country	:	US
Telephone Number	:	301-530-7234
Fax Number	:	301-530-7235

Provider Business Practice Location Address
First Line	:	5624 GREENTREE RD
Second Line	:
City	:	BETHESDA
State	:	MD
Zip	:	20817-3550
Country	:	US
Telephone Number	:	301-530-7234
Fax Number	:	301-530-7235

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

Provider Enumeration Date	:	07/08/2006
Last Update Date	:	07/08/2007

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