MEDICARE: ANN SMITH MSW

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	R027149-1	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	R-027149-1	OTHER	NY	SOCIALWORKCERTIFICATION

General Provider Information

NPI Number	:	1871616813
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANN SMITH MSW

Provider Business Mailing Address
First Line	:	61 E 3RD ST
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11218-1021
Country	:	US
Telephone Number	:	718-230-4826
Fax Number	:

Provider Business Practice Location Address
First Line	:	240 BERKELEY PL
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11217-3802
Country	:	US
Telephone Number	:	718-230-4826
Fax Number	:

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

Provider Enumeration Date	:	04/06/2007
Last Update Date	:	07/08/2007

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