MEDICARE: ANN M LEE

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	08151	MD

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	08151	OTHER	MD	MD BOARD OF SOCIAL WORK

General Provider Information

NPI Number	:	1841822186
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANN M LEE

Provider Business Mailing Address
First Line	:	4405 REX PL
Second Line	:
City	:	ROCKVILLE
State	:	MD
Zip	:	20853-1255
Country	:	US
Telephone Number	:	240-994-0199
Fax Number	:

Provider Business Practice Location Address
First Line	:	10400 CONNECTICUT AVE STE 215
Second Line	:
City	:	KENSINGTON
State	:	MD
Zip	:	20895-3941
Country	:	US
Telephone Number	:	240-994-0199
Fax Number	:

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

Provider Enumeration Date	:	02/05/2020
Last Update Date	:	02/05/2020

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Directions to “ ANN M LEE ” Practice Location

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