MEDICARE: MS. JUDITH NEWBURN SLANE LCSW-R

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	R045231-1	NY

General Provider Information

NPI Number	:	1417902404
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. JUDITH NEWBURN SLANE LCSW-R

Provider Business Mailing Address
First Line	:	420 8TH AVE
Second Line	:	APARTMENT #1-C
City	:	BROOKLYN
State	:	NY
Zip	:	11215-3564
Country	:	US
Telephone Number	:	646-734-8290
Fax Number	:	212-952-3391

Provider Business Practice Location Address
First Line	:	420 8TH AVE
Second Line	:	APARTMENT #1-C
City	:	BROOKLYN
State	:	NY
Zip	:	11215-3564
Country	:	US
Telephone Number	:	646-734-8290
Fax Number	:	212-952-3391

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

Provider Enumeration Date	:	05/24/2006
Last Update Date	:	11/01/2012

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