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NPI Code Detail

MEDICARE: MRS. ROXANNE EAGAN LMSW

MEDICARE: MRS. ROXANNE EAGAN 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
1104100000XSocial Worker054159-1NY

General Provider Information

NPI Number : 1235448051
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. ROXANNE EAGAN LMSW
Provider Business Mailing Address
First Line : 379 MT HOPE RD
Second Line :
City : MIDDLETOWN
State : NY
Zip : 10940-7135
Country : US
Telephone Number : 845-344-2292
Fax Number : 845-342-2054
Provider Business Practice Location Address
First Line : 379 MT HOPE RD
Second Line :
City : MIDDLETOWN
State : NY
Zip : 10940-7135
Country : US
Telephone Number : 845-344-2292
Fax Number : 845-342-2054
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/28/2010
Last Update Date : 09/28/2010

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