MEDICARE: MS. MARLEANA JACQUELINE RAD MSED

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	101YS0200X	School Counselor		NY

General Provider Information

NPI Number	:	1922659523
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. MARLEANA JACQUELINE RAD MSED

Provider Business Mailing Address
First Line	:	7909 FURMANVILLE AVE
Second Line	:
City	:	MIDDLE VILLAGE
State	:	NY
Zip	:	11379-2303
Country	:	US
Telephone Number	:	917-588-0395
Fax Number	:

Provider Business Practice Location Address
First Line	:	5808 16TH AVE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11204-2111
Country	:	US
Telephone Number	:	718-530-9446
Fax Number	:

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

Provider Enumeration Date	:	09/25/2019
Last Update Date	:	09/25/2019

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