MEDICARE: MS. LESLIE TRAWIN L.C.S.W

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	R056563-1	NY

General Provider Information

NPI Number	:	1548321417
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. LESLIE TRAWIN L.C.S.W

Provider Business Mailing Address
First Line	:	18 W 20TH ST
Second Line	:
City	:	BAYONNE
State	:	NJ
Zip	:	07002-3612
Country	:	US
Telephone Number	:	212-675-1748
Fax Number	:

Provider Business Practice Location Address
First Line	:	88 UNIVERSITY PL
Second Line	:	#803
City	:	NEW YORK
State	:	NY
Zip	:	10003-4513
Country	:	US
Telephone Number	:	212-675-1748
Fax Number	:

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

Provider Enumeration Date	:	12/13/2006
Last Update Date	:	07/08/2007

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