MEDICARE: LYDIA ROBERTSON STRAWBRIDGE 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	0904003695	VA

General Provider Information

NPI Number	:	1760709711
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LYDIA ROBERTSON STRAWBRIDGE LCSW

Provider Business Mailing Address
First Line	:	246 CHIVAS DR
Second Line	:
City	:	ROANOKE
State	:	VA
Zip	:	24019-8007
Country	:	US
Telephone Number	:	540-871-0204
Fax Number	:

Provider Business Practice Location Address
First Line	:	4330 OLD CAVE SPRING RD
Second Line	:
City	:	ROANOKE
State	:	VA
Zip	:	24018-3419
Country	:	US
Telephone Number	:	540-774-4211
Fax Number	:

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

Provider Enumeration Date	:	04/30/2010
Last Update Date	:	04/30/2010

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