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NPI Code Detail

MEDICARE: DR. LILLIAN BASCONE MCGOVERN PSY.D

MEDICARE: DR. LILLIAN BASCONE MCGOVERN PSY.D
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
1103T00000XPsychologist011112-1NY

General Provider Information

NPI Number : 1659627057
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. LILLIAN BASCONE MCGOVERN PSY.D
Provider Business Mailing Address
First Line : 555 REMSEN AVE
Second Line :
City : BROOKLYN
State : NY
Zip : 11236-1017
Country : US
Telephone Number : 718-495-3510
Fax Number : 718-495-5459
Provider Business Practice Location Address
First Line : 555 REMSEN AVE
Second Line :
City : BROOKLYN
State : NY
Zip : 11236-1017
Country : US
Telephone Number : 718-495-3510
Fax Number : 718-495-5459
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/03/2012
Last Update Date : 08/03/2012

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