MEDICARE: MS. ALBA LUZ CEBALLOS 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	066903-1	NY

General Provider Information

NPI Number	:	1699928960
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. ALBA LUZ CEBALLOS LMSW

Provider Business Mailing Address
First Line	:	14 PACKARD ST
Second Line	:
City	:	BAYONNE
State	:	NJ
Zip	:	07002-4922
Country	:	US
Telephone Number	:	201-436-4569
Fax Number	:	201-436-4569

Provider Business Practice Location Address
First Line	:	100 DEBS PL APT 23F
Second Line	:
City	:	BRONX
State	:	NY
Zip	:	10475-2504
Country	:	US
Telephone Number	:	917-214-4632
Fax Number	:

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

Provider Enumeration Date	:	10/30/2008
Last Update Date	:	10/30/2008

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