MEDICARE: ALBA E MARTE 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	104100000X	Social Worker	72074092	NY

General Provider Information

NPI Number	:	1104029842
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALBA E MARTE LMSW

Provider Business Mailing Address
First Line	:	555 W 171ST ST
Second Line	:	APT 54
City	:	NEW YORK
State	:	NY
Zip	:	10032-3309
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4119 WHITE PLAINS RD
Second Line	:
City	:	BRONX
State	:	NY
Zip	:	10466-3007
Country	:	US
Telephone Number	:	718-652-0227
Fax Number	:

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

Provider Enumeration Date	:	06/08/2007
Last Update Date	:	07/08/2007

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