MEDICARE: DWIGHT C BOSTON 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	0904003347	VA

General Provider Information

NPI Number	:	1730237009
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DWIGHT C BOSTON LCSW

Provider Business Mailing Address
First Line	:	318 S WEST ST
Second Line	:
City	:	CULPEPER
State	:	VA
Zip	:	22701-3132
Country	:	US
Telephone Number	:	540-829-6470
Fax Number	:	540-854-7416

Provider Business Practice Location Address
First Line	:	318 S WEST ST
Second Line	:
City	:	CULPEPER
State	:	VA
Zip	:	22701-3132
Country	:	US
Telephone Number	:	540-829-6470
Fax Number	:	540-854-7416

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

Provider Enumeration Date	:	01/05/2007
Last Update Date	:	02/23/2010

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