MEDICARE: MS. LINDA GERMAINE KOVALESKY-MCLAINE MSW

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	0904002689	VA

General Provider Information

NPI Number	:	1740264423
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. LINDA GERMAINE KOVALESKY-MCLAINE MSW

Provider Business Mailing Address
First Line	:	9017 GOLDEN SUNSET LN
Second Line	:
City	:	SPRINGFIELD
State	:	VA
Zip	:	22153-2454
Country	:	US
Telephone Number	:	703-934-2648
Fax Number	:	703-934-2718

Provider Business Practice Location Address
First Line	:	10560 MAIN ST
Second Line	:
City	:	FAIRFAX
State	:	VA
Zip	:	22030-7173
Country	:	US
Telephone Number	:	703-934-2648
Fax Number	:	703-934-2718

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

Provider Enumeration Date	:	12/06/2005
Last Update Date	:	07/08/2007

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