MEDICARE: JUDITH GRINGORTEN 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	R016606-1	NY

General Provider Information

NPI Number	:	1881617264
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JUDITH GRINGORTEN LCSW

Provider Business Mailing Address
First Line	:	17 LOWERRE PL
Second Line	:
City	:	VALLEY COTTAGE
State	:	NY
Zip	:	10989-2322
Country	:	US
Telephone Number	:	917-903-9665
Fax Number	:	212-214-0455

Provider Business Practice Location Address
First Line	:	853 BROADWAY
Second Line	:	SUITE 1608
City	:	NEW YORK
State	:	NY
Zip	:	10003-4703
Country	:	US
Telephone Number	:	212-982-8835
Fax Number	:	212-214-0455

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

Provider Enumeration Date	:	07/26/2006
Last Update Date	:	07/08/2007

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