MEDICARE: MRS. LAURA G. CLEMENT LCSW, LCSW-C, 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	0904007711	VA
2	1041C0700X	Clinical Social Worker	17180	MD
3	1041C0700X	Clinical Social Worker	LC50079108	DC

General Provider Information

NPI Number	:	1821317850
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. LAURA G. CLEMENT LCSW, LCSW-C, LICSW

Provider Business Mailing Address
First Line	:	4740 CONNECTICUT AVE NW
Second Line	:	APT. 504
City	:	WASHINGTON
State	:	DC
Zip	:	20008-5628
Country	:	US
Telephone Number	:	757-876-0643
Fax Number	:

Provider Business Practice Location Address
First Line	:	1495 CHAIN BRIDGE RD
Second Line	:	WEAVER AND ASSOCIATES, PLLC, STE 300
City	:	MC LEAN
State	:	VA
Zip	:	22101-5727
Country	:	US
Telephone Number	:	202-577-6836
Fax Number	:

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

Provider Enumeration Date	:	06/01/2010
Last Update Date	:	10/14/2011

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