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NPI Code Detail

MEDICARE: JENNIFER RACHAEL BAKAL LCSW

MEDICARE: JENNIFER RACHAEL BAKAL 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
11041C0700XClinical Social Worker070840-1NY

General Provider Information

NPI Number : 1578701579
Entity Type Code : Individual
Provider Name (Legal Business Name) : JENNIFER RACHAEL BAKAL LCSW
Provider Business Mailing Address
First Line : 215 E 96TH ST APT 17R
Second Line :
City : NEW YORK
State : NY
Zip : 10128-3947
Country : US
Telephone Number : 212-426-6826
Fax Number :
Provider Business Practice Location Address
First Line : 116 JOHN ST FL 27
Second Line :
City : NEW YORK
State : NY
Zip : 10038-3414
Country : US
Telephone Number : 212-385-0086
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/28/2009
Last Update Date : 01/28/2009

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