MEDICARE: MRS. VICKIE ELSESSER-VU LCSWC

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	06638	MD

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	06638	OTHER	MD	LICENSE LCSWC

General Provider Information

NPI Number	:	1912980350
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. VICKIE ELSESSER-VU LCSWC

Provider Business Mailing Address
First Line	:	41170 QUEEN ARBOR CT
Second Line	:
City	:	MECHANICSVILLE
State	:	MD
Zip	:	20659-3714
Country	:	US
Telephone Number	:	301-373-6362
Fax Number	:	301-373-6314

Provider Business Practice Location Address
First Line	:	27108 MT ZION CHURCH RD
Second Line	:
City	:	MECHANICSVILLE
State	:	MD
Zip	:	20659
Country	:	US
Telephone Number	:	301-904-0909
Fax Number	:	301-373-6314

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

Provider Enumeration Date	:	11/21/2005
Last Update Date	:	07/08/2007

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