MEDICARE: MS. JEANNE M FERNEKEES-BOYLAN 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	8031653-1	NY

General Provider Information

NPI Number	:	1740265321
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. JEANNE M FERNEKEES-BOYLAN LCSW

Provider Business Mailing Address
First Line	:	50 BROADWAY
Second Line	:	LEAGUE FOR THE HARD OF HEARING 6TH FL
City	:	NEW YORK
State	:	NY
Zip	:	10004-1607
Country	:	US
Telephone Number	:	917-305-7700
Fax Number	:	917-305-7741

Provider Business Practice Location Address
First Line	:	50 BROADWAY
Second Line	:	LEAGUE FOR THE HARD OF HEARING 6TH FL
City	:	NEW YORK
State	:	NY
Zip	:	10004-1607
Country	:	US
Telephone Number	:	917-305-7700
Fax Number	:	917-305-7741

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

Provider Enumeration Date	:	12/07/2005
Last Update Date	:	07/08/2007

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