MEDICARE: MR. EWAN DUARTE

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	LCSW128607	CA
2	1041C0700X	Clinical Social Worker	0904019375	VA

General Provider Information

NPI Number	:	1912635293
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. EWAN DUARTE

Provider Business Mailing Address
First Line	:	1445 RIO RD E STE 104
Second Line	:
City	:	CHARLOTTESVILLE
State	:	VA
Zip	:	22901-1751
Country	:	US
Telephone Number	:	434-202-3787
Fax Number	:	434-205-9594

Provider Business Practice Location Address
First Line	:	1445 RIO RD E STE 104
Second Line	:
City	:	CHARLOTTESVILLE
State	:	VA
Zip	:	22901-1751
Country	:	US
Telephone Number	:	434-202-3787
Fax Number	:	434-205-9594

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

Provider Enumeration Date	:	08/12/2022
Last Update Date	:	01/20/2026

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Directions to “ MR. EWAN DUARTE ” Practice Location

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