MEDICARE: KASHIMA THOMS-CLARK LCSW

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	070351	NY

General Provider Information

NPI Number	:	1053600536
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KASHIMA THOMS-CLARK LCSW

Provider Business Mailing Address
First Line	:	25 WOODROW PKWY
Second Line	:
City	:	WEST BABYLON
State	:	NY
Zip	:	11704-7314
Country	:	US
Telephone Number	:	347-879-1652
Fax Number	:

Provider Business Practice Location Address
First Line	:	1850 AMSTERDAM AVE BSMT
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10031-1714
Country	:	US
Telephone Number	:	644-773-7012
Fax Number	:

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

Provider Enumeration Date	:	04/05/2011
Last Update Date	:	05/20/2024

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