MEDICARE: MRS. MARILYN SANDE-FRIEDMAN 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	PR013009-1	NY

General Provider Information

NPI Number	:	1083882344
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. MARILYN SANDE-FRIEDMAN LCSW

Provider Business Mailing Address
First Line	:	1123 PARK AVE.
Second Line	:	1D
City	:	NEW YORK
State	:	NY
Zip	:	10128-1241
Country	:	US
Telephone Number	:	212-289-2435
Fax Number	:	212-289-7626

Provider Business Practice Location Address
First Line	:	1123 PARK AVE.
Second Line	:	1D
City	:	NY
State	:	NY
Zip	:	10128-1241
Country	:	US
Telephone Number	:	212-289-2435
Fax Number	:	212-289-7626

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

Provider Enumeration Date	:	02/20/2008
Last Update Date	:	01/26/2012

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