MEDICARE: MRS. LISA MARIE GUGGINO-MOSES 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	070421-1	NY

General Provider Information

NPI Number	:	1922156223
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. LISA MARIE GUGGINO-MOSES LCSW

Provider Business Mailing Address
First Line	:	999 HIDDEN LAKE DR
Second Line	:	APT. 19C
City	:	NORTH BRUNSWICK
State	:	NJ
Zip	:	08902-1166
Country	:	US
Telephone Number	:	917-847-7695
Fax Number	:

Provider Business Practice Location Address
First Line	:	3974 AMBOY RD
Second Line	:	SUITE 306
City	:	STATEN ISLAND
State	:	NY
Zip	:	10308-2414
Country	:	US
Telephone Number	:	917-847-7695
Fax Number	:

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

Provider Enumeration Date	:	01/05/2007
Last Update Date	:	07/08/2007

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