MEDICARE: ANTHONY GEORGES LCSWR

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	104100000X	Social Worker	059349-R	NY
2	1041C0700X	Clinical Social Worker	059349-R	NY

General Provider Information

NPI Number	:	1043408305
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANTHONY GEORGES LCSWR

Provider Business Mailing Address
First Line	:	1550 RICHMOND AVE STE 203
Second Line	:
City	:	STATEN ISLAND
State	:	NY
Zip	:	10314-1578
Country	:	US
Telephone Number	:	718-370-1250
Fax Number	:	718-698-0625

Provider Business Practice Location Address
First Line	:	3005 GLENWOOD RD
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11210-2641
Country	:	US
Telephone Number	:	718-434-7900
Fax Number	:	718-434-6715

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

Provider Enumeration Date	:	10/11/2007
Last Update Date	:	10/23/2023

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