MEDICARE: JILL NAWROCKI

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	087997	NY

General Provider Information

NPI Number	:	1083262026
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JILL NAWROCKI

Provider Business Mailing Address
First Line	:	199 BRIDGE ST APT 4R
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11201-2015
Country	:	US
Telephone Number	:	917-370-7330
Fax Number	:

Provider Business Practice Location Address
First Line	:	525 COURT ST
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11231-3910
Country	:	US
Telephone Number	:	917-370-7330
Fax Number	:

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

Provider Enumeration Date	:	09/03/2019
Last Update Date	:	09/03/2019

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