MEDICARE: MUZA GUZBAND 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	R054215-1	NY

General Provider Information

NPI Number	:	1730297268
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MUZA GUZBAND LCSW

Provider Business Mailing Address
First Line	:	2898 W 8TH ST
Second Line	:	11L
City	:	BROOKLYN
State	:	NY
Zip	:	11224-3351
Country	:	US
Telephone Number	:	718-373-8676
Fax Number	:	718-383-8657

Provider Business Practice Location Address
First Line	:	2379 65TH ST
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11204-4045
Country	:	US
Telephone Number	:	718-375-0392
Fax Number	:	718-375-4324

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

Provider Enumeration Date	:	08/25/2006
Last Update Date	:	07/08/2007

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