MEDICARE: MRS. ELIZA CASSIN 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	104100000X	Social Worker	105647-1	NY

General Provider Information

NPI Number	:	1700404761
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. ELIZA CASSIN LMSW

Provider Business Mailing Address
First Line	:	50 COLUMBUS AVE
Second Line	:
City	:	TUCKAHOE
State	:	NY
Zip	:	10707-2527
Country	:	US
Telephone Number	:	914-643-5062
Fax Number	:

Provider Business Practice Location Address
First Line	:	50 COLUMBUS AVE
Second Line	:
City	:	TUCKAHOE
State	:	NY
Zip	:	10707-2527
Country	:	US
Telephone Number	:	914-643-5062
Fax Number	:

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

Provider Enumeration Date	:	07/07/2020
Last Update Date	:	07/07/2020

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