MEDICARE: MCKENZIE D CASAD MSW,LCSW, CD

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	374J00000X	Doula
2	1041C0700X	Clinical Social Worker	0904006940	VA

General Provider Information

NPI Number	:	1952630220
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MCKENZIE D CASAD MSW,LCSW, CD

Provider Business Mailing Address
First Line	:	7237 TOWLES MILL RD
Second Line	:
City	:	SPOTSYLVANIA
State	:	VA
Zip	:	22551-3234
Country	:	US
Telephone Number	:	757-553-2780
Fax Number	:

Provider Business Practice Location Address
First Line	:	2117 W MAIN ST
Second Line	:
City	:	RICHMOND
State	:	VA
Zip	:	23220-4527
Country	:	US
Telephone Number	:	757-553-2780
Fax Number	:

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

Provider Enumeration Date	:	12/16/2009
Last Update Date	:	02/19/2010

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