MEDICARE: JOANN P WEISBORD 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	R033911-1	NY

General Provider Information

NPI Number	:	1528146222
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOANN P WEISBORD LCSW

Provider Business Mailing Address
First Line	:	999 CENTRAL AVE
Second Line	:	SUITE 207
City	:	WOODMERE
State	:	NY
Zip	:	11598-1205
Country	:	US
Telephone Number	:	516-295-4442
Fax Number	:	516-295-3195

Provider Business Practice Location Address
First Line	:	999 CENTRAL AVE
Second Line	:	SUITE 207
City	:	WOODMERE
State	:	NY
Zip	:	11598-1205
Country	:	US
Telephone Number	:	516-295-4442
Fax Number	:	516-295-3195

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

Provider Enumeration Date	:	11/01/2006
Last Update Date	:	07/08/2007

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