MEDICARE: PRERNA MENON

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	104541	NY
2	1041C0700X	Clinical Social Worker	092917	NY

General Provider Information

NPI Number	:	1053938126
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PRERNA MENON

Provider Business Mailing Address
First Line	:	442 5TH AVE # 2537
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10018-2794
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	319 AVENUE C
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10009-1618
Country	:	US
Telephone Number	:	929-274-2255
Fax Number	:

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

Provider Enumeration Date	:	07/06/2020
Last Update Date	:	09/18/2024

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Directions to “ PRERNA MENON ” Practice Location

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