MEDICARE: MS. SYLVIA INDIO 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	048385	NY

General Provider Information

NPI Number	:	1619033198
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. SYLVIA INDIO LCSW

Provider Business Mailing Address
First Line	:	8208 135TH ST
Second Line	:	2H
City	:	JAMAICA
State	:	NY
Zip	:	11435-1331
Country	:	US
Telephone Number	:	917-501-1197
Fax Number	:	718-268-0460

Provider Business Practice Location Address
First Line	:	10923 71ST RD
Second Line	:	1H
City	:	FOREST HILLS
State	:	NY
Zip	:	11375-4849
Country	:	US
Telephone Number	:	718-268-1223
Fax Number	:	718-268-0460

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

Provider Enumeration Date	:	12/28/2006
Last Update Date	:	07/08/2007

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