MEDICARE: DR. VERONICA M WANZER LCPC

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	101YP2500X	Professional Counselor

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	5170	OTHER	MD	LICENSE NUMBER

General Provider Information

NPI Number	:	1871877654
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. VERONICA M WANZER LCPC

Provider Business Mailing Address
First Line	:	509 QUINCE ORCHARD RD # 129
Second Line	:
City	:	GAITHERSBURG
State	:	MD
Zip	:	20878-1435
Country	:	US
Telephone Number	:	240-427-5547
Fax Number	:	240-465-0422

Provider Business Practice Location Address
First Line	:	509 QUINCE ORCHARD RD # 129
Second Line	:
City	:	GAITHERSBURG
State	:	MD
Zip	:	20878-1435
Country	:	US
Telephone Number	:	240-427-5547
Fax Number	:	240-465-0422

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

Provider Enumeration Date	:	09/28/2011
Last Update Date	:	08/11/2020

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