MEDICARE: ELIZABETH MARY EMEN 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	LC5549	MD

General Provider Information

NPI Number	:	1710402383
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ELIZABETH MARY EMEN LCPC

Provider Business Mailing Address
First Line	:	9900 GEORGIA AVE APT 218
Second Line	:
City	:	SILVER SPRING
State	:	MD
Zip	:	20902-5242
Country	:	US
Telephone Number	:	802-578-5794
Fax Number	:

Provider Business Practice Location Address
First Line	:	4000 BLACKBURN LN
Second Line	:
City	:	BURTONSVILLE
State	:	MD
Zip	:	20866-1104
Country	:	US
Telephone Number	:	802-578-5794
Fax Number	:	802-578-5794

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

Provider Enumeration Date	:	08/04/2017
Last Update Date	:	08/04/2017

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