MEDICARE: EVA ISMAN 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	034121	NY

General Provider Information

NPI Number	:	1427297167
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EVA ISMAN LCSW

Provider Business Mailing Address
First Line	:	751 WESTMINSTER RD
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11230-2401
Country	:	US
Telephone Number	:	347-256-6152
Fax Number	:

Provider Business Practice Location Address
First Line	:	1420 BUSHWICK AVE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11207-1422
Country	:	US
Telephone Number	:	718-602-1000
Fax Number	:	718-602-1111

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

Provider Enumeration Date	:	02/19/2009
Last Update Date	:	02/19/2009

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