MEDICARE: SUSANNA O. MCNAMARA,LCSW-C, LLC

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	11540	MD

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1041C0700X	OTHER	MD	PRIMARY TAXONOMY
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1942694682
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SUSANNA O. MCNAMARA,LCSW-C, LLC

Provider Business Mailing Address
First Line	:	42180 CIDER LN
Second Line	:
City	:	HOLLYWOOD
State	:	MD
Zip	:	20636-2387
Country	:	US
Telephone Number	:	301-373-8765
Fax Number	:

Provider Business Practice Location Address
First Line	:	21945 THREE NOTCH RD
Second Line	:	SUITE 103
City	:	LEXINGTON PARK
State	:	MD
Zip	:	20653-1562
Country	:	US
Telephone Number	:	301-997-1494
Fax Number	:	410-586-3674

Authorized Official
Title or Position	:	PSYCHOTHERAPIST
Name	:	MRS. SUSANNA OKSANA MCNAMARA
Credential	:	LCSW-C
Telephone Number	:	301-373-8765

Provider Enumeration Date	:	03/19/2015
Last Update Date	:	03/19/2015

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