MEDICARE: MR. RACHID BAGANA 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	19377	MD

General Provider Information

NPI Number	:	1972938629
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. RACHID BAGANA LCSW-C

Provider Business Mailing Address
First Line	:	13906 CASTLE BLVD APT 304
Second Line	:
City	:	SILVER SPRING
State	:	MD
Zip	:	20904-4943
Country	:	US
Telephone Number	:	205-410-0456
Fax Number	:

Provider Business Practice Location Address
First Line	:	13906 CASTLE BLVD APT 304
Second Line	:
City	:	SILVER SPRING
State	:	MD
Zip	:	20904-4943
Country	:	US
Telephone Number	:	205-410-0456
Fax Number	:

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

Provider Enumeration Date	:	09/12/2013
Last Update Date	:	09/12/2013

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