MEDICARE: MR. SCOTT K. BIRDSONG LCSW-C

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	00498	MD

General Provider Information

NPI Number	:	1962526772
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. SCOTT K. BIRDSONG LCSW-C

Provider Business Mailing Address
First Line	:	8643 CHERRY LN
Second Line	:
City	:	LAUREL
State	:	MD
Zip	:	20707-6200
Country	:	US
Telephone Number	:	301-549-3602
Fax Number	:	301-549-3605

Provider Business Practice Location Address
First Line	:	8643 CHERRY LN
Second Line	:
City	:	LAUREL
State	:	MD
Zip	:	20707-6200
Country	:	US
Telephone Number	:	301-549-3602
Fax Number	:	301-549-3605

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

Provider Enumeration Date	:	03/19/2007
Last Update Date	:	07/08/2007

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Directions to “ MR. SCOTT K. BIRDSONG LCSW-C” Practice Location

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