MEDICARE: MS. HOLLY HEYWARD DANDO LCSW-R

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	R042285-1	NY

General Provider Information

NPI Number	:	1598188674
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. HOLLY HEYWARD DANDO LCSW-R

Provider Business Mailing Address
First Line	:	53 W 23RD ST
Second Line	:	6TH FLOOR
City	:	NEW YORK
State	:	NY
Zip	:	10010-4204
Country	:	US
Telephone Number	:	212-746-7178
Fax Number	:	212-746-7197

Provider Business Practice Location Address
First Line	:	53 W 23RD ST
Second Line	:	6TH FLOOR
City	:	NEW YORK
State	:	NY
Zip	:	10010-4204
Country	:	US
Telephone Number	:	212-746-7178
Fax Number	:	212-746-7197

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

Provider Enumeration Date	:	01/27/2014
Last Update Date	:	01/27/2014

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