MEDICARE: ELIZABETH C KRUEGER

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	19763	MD

General Provider Information

NPI Number	:	1700363223
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ELIZABETH C KRUEGER

Provider Business Mailing Address
First Line	:	1801 NEWTON ST NW APT 4
Second Line	:
City	:	WASHINGTON
State	:	DC
Zip	:	20010-1016
Country	:	US
Telephone Number	:	202-215-4559
Fax Number	:

Provider Business Practice Location Address
First Line	:	10230 NEW HAMPSHIRE AVE STE 206
Second Line	:
City	:	SILVER SPRING
State	:	MD
Zip	:	20903-1423
Country	:	US
Telephone Number	:	301-439-6700
Fax Number	:

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

Provider Enumeration Date	:	07/26/2018
Last Update Date	:	07/26/2018

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