MEDICARE: ANNA CAMPBELL PRUM 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	0904009352	VA
2	1041C0700X	Clinical Social Worker	LC50080713	DC

General Provider Information

NPI Number	:	1679925564
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANNA CAMPBELL PRUM LCSW

Provider Business Mailing Address
First Line	:	2417 CENTRAL AVE
Second Line	:
City	:	ALEXANDRIA
State	:	VA
Zip	:	22302-3203
Country	:	US
Telephone Number	:	703-431-5148
Fax Number	:

Provider Business Practice Location Address
First Line	:	2300 MARTIN LUTHER KING JR AVE SE FL 5
Second Line	:
City	:	WASHINGTON
State	:	DC
Zip	:	20020-5807
Country	:	US
Telephone Number	:	202-528-5154
Fax Number	:

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

Provider Enumeration Date	:	07/05/2016
Last Update Date	:	07/05/2016

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