MEDICARE: MARIA GLEBA CASAC-T

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	101Y00000X	Counselor

General Provider Information

NPI Number	:	1881978922
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARIA GLEBA CASAC-T

Provider Business Mailing Address
First Line	:	5220 4TH AVE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11220-1812
Country	:	US
Telephone Number	:	718-360-8157
Fax Number	:	718-439-3965

Provider Business Practice Location Address
First Line	:	5220 4TH AVE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11220-1812
Country	:	US
Telephone Number	:	718-360-8157
Fax Number	:	718-439-3965

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

Provider Enumeration Date	:	10/07/2011
Last Update Date	:	10/07/2011

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