MEDICARE: MS. CYNTHIA LOCKE HENDERSON LICSW, LCSW-C

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	LC302082	DC
2	1041C0700X	Clinical Social Worker	08086	MD

General Provider Information

NPI Number	:	1689708638
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. CYNTHIA LOCKE HENDERSON LICSW, LCSW-C

Provider Business Mailing Address
First Line	:	526 E INDIAN SPRING DR
Second Line	:
City	:	SILVER SPRING
State	:	MD
Zip	:	20901-4727
Country	:	US
Telephone Number	:	301-587-3376
Fax Number	:

Provider Business Practice Location Address
First Line	:	2811 PENNSYLVANIA AVE SE
Second Line	:
City	:	WASHINGTON
State	:	DC
Zip	:	20020-3865
Country	:	US
Telephone Number	:	202-581-2455
Fax Number	:

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

Provider Enumeration Date	:	03/14/2007
Last Update Date	:	07/08/2007

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