MEDICARE: JANE C BARDAVID 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	R013203-1	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

General Provider Information

NPI Number	:	1558399642
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JANE C BARDAVID LCSW

Provider Business Mailing Address
First Line	:	101 W END AVE
Second Line	:	APT 30E
City	:	NEW YORK
State	:	NY
Zip	:	10023-6379
Country	:	US
Telephone Number	:	718-224-0566
Fax Number	:	718-224-7544

Provider Business Practice Location Address
First Line	:	1 BARSTOW RD
Second Line	:	STE P24
City	:	GREAT NECK
State	:	NY
Zip	:	11021-3501
Country	:	US
Telephone Number	:	516-978-8629
Fax Number	:	212-362-3908

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

Provider Enumeration Date	:	06/29/2006
Last Update Date	:	04/20/2016

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Directions to “ JANE C BARDAVID LCSW” Practice Location

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