MEDICARE: ROSALIS DURAN

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	104100000X	Social Worker	118400-01	NY

General Provider Information

NPI Number	:	1609577030
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ROSALIS DURAN

Provider Business Mailing Address
First Line	:	452 MARCY AVE APT 5A
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11206-7406
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	452 MARCY AVE APT 5A
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11206-7406
Country	:	US
Telephone Number	:	917-444-0547
Fax Number	:

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

Provider Enumeration Date	:	03/13/2023
Last Update Date	:	03/13/2023

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