MEDICARE: JASMIN AMARILLAS 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	091680	NY
2	101YM0800X	Mental Health Counselor

General Provider Information

NPI Number	:	1730439035
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JASMIN AMARILLAS LCSW

Provider Business Mailing Address
First Line	:	123 GROVE AVE STE 204
Second Line	:
City	:	CEDARHURST
State	:	NY
Zip	:	11516-2302
Country	:	US
Telephone Number	:	516-350-8564
Fax Number	:	562-924-5526

Provider Business Practice Location Address
First Line	:	123 GROVE AVE STE 216
Second Line	:
City	:	CEDARHURST
State	:	NY
Zip	:	11516-2302
Country	:	US
Telephone Number	:	516-350-8564
Fax Number	:

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

Provider Enumeration Date	:	09/13/2012
Last Update Date	:	07/28/2021

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