MEDICARE: PARK SLOPE CREATIVE CENTER

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	221700000X	Art Therapist	000302	NY
2	1041C0700X	Clinical Social Worker	074666	NY

General Provider Information

NPI Number	:	1043562705
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PARK SLOPE CREATIVE CENTER

Provider Business Mailing Address
First Line	:	20 KINGS MILL RD
Second Line	:
City	:	MONROE
State	:	NJ
Zip	:	08831-8902
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	355 5TH ST
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11215-2806
Country	:	US
Telephone Number	:	917-941-2652
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MARYGRACE BERBERIAN
Credential	:	ATR-BC, LCSW, LCAT
Telephone Number	:	917-941-2652

Provider Enumeration Date	:	10/04/2012
Last Update Date	:	10/04/2012

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Directions to “PARK SLOPE CREATIVE CENTER ” Practice Location

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