MEDICARE: CLEMENCIA M THOMAS

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	101Y00000X	Counselor

General Provider Information

NPI Number	:	1154408979
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CLEMENCIA M THOMAS

Provider Business Mailing Address
First Line	:	147 BAINBRIDGE ST
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11233-1801
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	55 WESTCHESTER SQUARE
Second Line	:
City	:	BRONX
State	:	NY
Zip	:	10461-1801
Country	:	US
Telephone Number	:	718-931-4045
Fax Number	:

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

Provider Enumeration Date	:	11/01/2006
Last Update Date	:	07/08/2007

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