MEDICARE: BARBARA P JANNAH 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	0904002296	VA

General Provider Information

NPI Number	:	1871599670
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BARBARA P JANNAH LCSW

Provider Business Mailing Address
First Line	:	1385 MATTHEW TALBOT RD
Second Line	:
City	:	FOREST
State	:	VA
Zip	:	24551-4479
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1120 MCCONVILLE RD
Second Line	:	STE A
City	:	LYNCHBURG
State	:	VA
Zip	:	24502-4534
Country	:	US
Telephone Number	:	434-237-4652
Fax Number	:	434-237-4804

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

Provider Enumeration Date	:	06/27/2005
Last Update Date	:	07/08/2007

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