MEDICARE: VINESSA TRAMAINE OWEN MSW,SUPERVISEE IN SW

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	0904020136	VA

General Provider Information

NPI Number	:	1891642849
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	VINESSA TRAMAINE OWEN MSW,SUPERVISEE IN SW

Provider Business Mailing Address
First Line	:	111 MUSKET CIR
Second Line	:
City	:	SUFFOLK
State	:	VA
Zip	:	23434-4088
Country	:	US
Telephone Number	:	757-698-0981
Fax Number	:

Provider Business Practice Location Address
First Line	:	111 MUSKET CIR
Second Line	:
City	:	SUFFOLK
State	:	VA
Zip	:	23434-4088
Country	:	US
Telephone Number	:	757-698-0981
Fax Number	:

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

Provider Enumeration Date	:	03/10/2026
Last Update Date	:	03/22/2026

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