MEDICARE: MR. JERRY ALLAN WEINSOCK MA, LMHC

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	101YM0800X	Mental Health Counselor	004057	NY

General Provider Information

NPI Number	:	1881838076
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. JERRY ALLAN WEINSOCK MA, LMHC

Provider Business Mailing Address
First Line	:	460 W 34TH ST.
Second Line	:	12TH FLOOR YAI/NIPD
City	:	NEW YORK
State	:	NY
Zip	:	10001
Country	:	US
Telephone Number	:	212-273-6187
Fax Number	:	212-273-6536

Provider Business Practice Location Address
First Line	:	460 W 34TH STREET
Second Line	:	12TH FLOOR YAI/NIPD
City	:	NEW YORK
State	:	NY
Zip	:	10001-2382
Country	:	US
Telephone Number	:	212-273-6187
Fax Number	:	212-273-6536

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

Provider Enumeration Date	:	05/01/2009
Last Update Date	:	05/01/2009

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