MEDICARE: MS. ANN E. BADGER 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	LCSW 11396	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	11514472	OTHER	NY	CAQH PROVIDER ID
3	0087029	OTHER	NY	GHI PIN

General Provider Information

NPI Number	:	1508985433
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. ANN E. BADGER LCSW

Provider Business Mailing Address
First Line	:	121 IROQUOIS LN
Second Line	:
City	:	LIVERPOOL
State	:	NY
Zip	:	13088-4447
Country	:	US
Telephone Number	:	315-451-5192
Fax Number	:

Provider Business Practice Location Address
First Line	:	403 TULIP ST
Second Line	:
City	:	LIVERPOOL
State	:	NY
Zip	:	13088-4966
Country	:	US
Telephone Number	:	315-451-2318
Fax Number	:

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

Provider Enumeration Date	:	03/29/2007
Last Update Date	:	07/09/2007

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Directions to “ MS. ANN E. BADGER LCSW” Practice Location

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