MEDICARE: THE IN-HOME PSYCHOTHERAPY SERVICE OF GREATER NY, LCSW, P.C.

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	R025860-1	NY

General Provider Information

NPI Number	:	1548266638
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	THE IN-HOME PSYCHOTHERAPY SERVICE OF GREATER NY, LCSW, P.C.

Provider Business Mailing Address
First Line	:	3706 BERNE RD
Second Line	:
City	:	WANTAGH
State	:	NY
Zip	:	11793-3114
Country	:	US
Telephone Number	:	516-785-6433
Fax Number	:

Provider Business Practice Location Address
First Line	:	3706 BERNE RD
Second Line	:
City	:	WANTAGH
State	:	NY
Zip	:	11793-3114
Country	:	US
Telephone Number	:	516-785-6433
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. DAVID BINDER
Credential	:	LCSW
Telephone Number	:	516-785-6433

Provider Enumeration Date	:	06/22/2005
Last Update Date	:	08/11/2008

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