MEDICARE: MR. WILLIAM MESSINA 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	R02865-1	NY

General Provider Information

NPI Number	:	1710051917
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. WILLIAM MESSINA LCSW

Provider Business Mailing Address
First Line	:	130 5TH AVE
Second Line	:	SUITE 900
City	:	NEW YORK
State	:	NY
Zip	:	10011-4306
Country	:	US
Telephone Number	:	212-591-0208
Fax Number	:

Provider Business Practice Location Address
First Line	:	130 5TH AVE
Second Line	:	SUITE 900
City	:	NEW YORK
State	:	NY
Zip	:	10011-4306
Country	:	US
Telephone Number	:	212-591-0208
Fax Number	:

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

Provider Enumeration Date	:	11/20/2006
Last Update Date	:	04/02/2008

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