MEDICARE: MRS. SANDRA ROSE DUNCANSON LCSW-R

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	R045442-1	NY

General Provider Information

NPI Number	:	1720234628
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. SANDRA ROSE DUNCANSON LCSW-R

Provider Business Mailing Address
First Line	:	5415 CRESTWOOD RD
Second Line	:
City	:	BEMUS POINT
State	:	NY
Zip	:	14712-9631
Country	:	US
Telephone Number	:	716-499-5258
Fax Number	:

Provider Business Practice Location Address
First Line	:	5415 CRESTWOOD RD
Second Line	:
City	:	BEMUS POINT
State	:	NY
Zip	:	14712-9631
Country	:	US
Telephone Number	:	716-499-5258
Fax Number	:

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

Provider Enumeration Date	:	08/11/2008
Last Update Date	:	08/11/2008

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