MEDICARE: MATTHEW MARKOWICZ 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	0904013946	VA

General Provider Information

NPI Number	:	1750002275
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MATTHEW MARKOWICZ LCSW

Provider Business Mailing Address
First Line	:	7209 ELKHARDT RD
Second Line	:
City	:	NORTH CHESTERFIELD
State	:	VA
Zip	:	23225-7413
Country	:	US
Telephone Number	:	847-380-0986
Fax Number	:

Provider Business Practice Location Address
First Line	:	10611 PATTERSON AVE
Second Line	:
City	:	HENRICO
State	:	VA
Zip	:	23238-4733
Country	:	US
Telephone Number	:	804-592-0811
Fax Number	:

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

Provider Enumeration Date	:	09/05/2022
Last Update Date	:	09/05/2022

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