MEDICARE: TERESA E CANO LMSW

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	080682-1	NY

General Provider Information

NPI Number	:	1073828885
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TERESA E CANO LMSW

Provider Business Mailing Address
First Line	:	549 W 180TH ST
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10033-5849
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	5 FORDHAM HILL OVAL APT 14G
Second Line	:
City	:	BRONX
State	:	NY
Zip	:	10468-4765
Country	:	US
Telephone Number	:	917-407-2633
Fax Number	:

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

Provider Enumeration Date	:	08/17/2010
Last Update Date	:	08/17/2010

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