MEDICARE: RAQUEL WEINUM 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	TPSW3391	FL
2	1041C0700X	Clinical Social Worker	8998	TN
3	1041C0700X	Clinical Social Worker	078309	NY

General Provider Information

NPI Number	:	1740341031
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RAQUEL WEINUM LCSW

Provider Business Mailing Address
First Line	:	PO BOX 24449
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10087-0589
Country	:	US
Telephone Number	:	833-351-8255
Fax Number	:

Provider Business Practice Location Address
First Line	:	109 W 27TH ST STE 5S
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10001-0265
Country	:	US
Telephone Number	:	332-230-4572
Fax Number	:

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

Provider Enumeration Date	:	12/12/2006
Last Update Date	:	10/21/2024

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