MEDICARE: JEANETTE LUCIANO L.C.S.W.

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	074299-1	NY

General Provider Information

NPI Number	:	1104078930
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JEANETTE LUCIANO L.C.S.W.

Provider Business Mailing Address
First Line	:	8333 118TH STREET
Second Line	:	#2L
City	:	KEW GARDENS
State	:	NY
Zip	:	11415-2337
Country	:	US
Telephone Number	:	347-622-2175
Fax Number	:

Provider Business Practice Location Address
First Line	:	19 WEST 34TH STREET
Second Line	:	PH
City	:	NEW YORK CITY
State	:	NY
Zip	:	10001-3006
Country	:	US
Telephone Number	:	347-622-2175
Fax Number	:

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

Provider Enumeration Date	:	10/10/2008
Last Update Date	:	10/10/2008

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