MEDICARE: MRS. KATHLEEN ANN FERDINAND 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		NY

General Provider Information

NPI Number	:	1255530986
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. KATHLEEN ANN FERDINAND LCSW

Provider Business Mailing Address
First Line	:	14 IRVING ST
Second Line	:
City	:	VALLEY STREAM
State	:	NY
Zip	:	11580-2234
Country	:	US
Telephone Number	:	516-812-9227
Fax Number	:

Provider Business Practice Location Address
First Line	:	14 IRVING ST
Second Line	:
City	:	VALLEY STREAM
State	:	NY
Zip	:	11580-2234
Country	:	US
Telephone Number	:	516-812-9227
Fax Number	:

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

Provider Enumeration Date	:	07/12/2007
Last Update Date	:	07/12/2007

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