MEDICARE: ASHA PHILIP 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

General Provider Information

NPI Number	:	1427682541
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ASHA PHILIP LCSW

Provider Business Mailing Address
First Line	:	260 W MAIN ST STE 8
Second Line	:
City	:	BAY SHORE
State	:	NY
Zip	:	11706-8322
Country	:	US
Telephone Number	:	631-647-9009
Fax Number	:	631-647-8992

Provider Business Practice Location Address
First Line	:	3010 W 33RD ST
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11224-1404
Country	:	US
Telephone Number	:	631-647-9009
Fax Number	:	631-647-8992

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

Provider Enumeration Date	:	02/27/2020
Last Update Date	:	02/27/2020

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