MEDICARE: MS. KRISTIE POSTORINO LICSW

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	LC50077776	DC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	M6590001	OTHER	DC	MAGELLAN HEALTH CARE

General Provider Information

NPI Number	:	1770798415
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. KRISTIE POSTORINO LICSW

Provider Business Mailing Address
First Line	:	4115 WISCONSIN AVE NW
Second Line	:	SUITE 107
City	:	WASHINGTON
State	:	DC
Zip	:	20016-2812
Country	:	US
Telephone Number	:	202-215-4599
Fax Number	:

Provider Business Practice Location Address
First Line	:	4115 WISCONSIN AVE NW
Second Line	:	SUITE 107
City	:	WASHINGTON
State	:	DC
Zip	:	20016-2812
Country	:	US
Telephone Number	:	202-215-4599
Fax Number	:

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

Provider Enumeration Date	:	05/14/2007
Last Update Date	:	07/08/2007

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