MEDICARE: JOANN LUSTER LGSW

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	101Y00000X	Counselor

General Provider Information

NPI Number	:	1750415311
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOANN LUSTER LGSW

Provider Business Mailing Address
First Line	:	5410 SHERIFF RD
Second Line	:
City	:	CAPITOL HEIGHTS
State	:	MD
Zip	:	20743-1410
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3849 ALABAMA AVE SE
Second Line	:
City	:	WASHINGTON
State	:	DC
Zip	:	20020-1001
Country	:	US
Telephone Number	:	202-645-7258
Fax Number	:	202-645-7270

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

Provider Enumeration Date	:	03/15/2007
Last Update Date	:	07/08/2007

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