MEDICARE: MS. MICHELINA LEONE-FLICK 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	R028481-1	NY

General Provider Information

NPI Number	:	1891136305
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. MICHELINA LEONE-FLICK LCSW

Provider Business Mailing Address
First Line	:	201 E 15TH ST
Second Line	:	5E
City	:	NEW YORK
State	:	NY
Zip	:	10003-3723
Country	:	US
Telephone Number	:	212-673-3625
Fax Number	:	212-260-2757

Provider Business Practice Location Address
First Line	:	201 E 15TH ST
Second Line	:	5E
City	:	NEW YORK
State	:	NY
Zip	:	10003-3723
Country	:	US
Telephone Number	:	212-673-3625
Fax Number	:	212-260-2757

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

Provider Enumeration Date	:	07/12/2013
Last Update Date	:	07/12/2013

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