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NPI Code Detail

MEDICARE: BEWILBERTLLC

MEDICARE: BEWILBERTLLC
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
11041C0700XClinical Social Worker

General Provider Information

NPI Number : 1821690322
Entity Type Code : Organization
Provider Name (Legal Business Name) : BEWILBERTLLC
Provider Business Mailing Address
First Line : 721 FARRAGUT PL NE
Second Line :
City : WASHINGTON
State : DC
Zip : 20017-2364
Country : US
Telephone Number : 617-962-2484
Fax Number :
Provider Business Practice Location Address
First Line : 1350 CONNECTICUT AVE NW STE 500
Second Line :
City : WASHINGTON
State : DC
Zip : 20036-1736
Country : US
Telephone Number : 240-391-7350
Fax Number :
Authorized Official
Title or Position : CLINICAL SOCIAL WORKER
Name : MS. DANETTE LAWRENCE
Credential : LICSW, LCSW-C
Telephone Number : 617-962-2484
Provider Enumeration Date : 11/10/2020
Last Update Date : 11/10/2020

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