MEDICARE: MS. BEVERLY HOLSTUN LYNCH 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	0904000656	VA

General Provider Information

NPI Number	:	1679697528
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. BEVERLY HOLSTUN LYNCH LCSW

Provider Business Mailing Address
First Line	:	6313 MORI ST
Second Line	:
City	:	MC LEAN
State	:	VA
Zip	:	22101-3153
Country	:	US
Telephone Number	:	703-556-9509
Fax Number	:	703-556-9528

Provider Business Practice Location Address
First Line	:	6313 MORI ST
Second Line	:
City	:	MC LEAN
State	:	VA
Zip	:	22101-3153
Country	:	US
Telephone Number	:	703-556-9509
Fax Number	:	703-556-9528

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

Provider Enumeration Date	:	03/18/2007
Last Update Date	:	07/08/2007

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