MEDICARE: MS. PAULINE PARKES LMSW

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	078135	NY

General Provider Information

NPI Number	:	1679658520
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. PAULINE PARKES LMSW

Provider Business Mailing Address
First Line	:	1023 E 226TH ST
Second Line	:
City	:	BRONX
State	:	NY
Zip	:	10466-4827
Country	:	US
Telephone Number	:	646-372-4253
Fax Number	:

Provider Business Practice Location Address
First Line	:	2024 WILLIAMSBRIDGE RD
Second Line	:	STE 6
City	:	BRONX
State	:	NY
Zip	:	10461-1634
Country	:	US
Telephone Number	:	646-372-4253
Fax Number	:

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

Provider Enumeration Date	:	10/26/2006
Last Update Date	:	01/16/2017

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