MEDICARE: MS. MARTINE J BARON 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	R063659-1	NY

General Provider Information

NPI Number	:	1962639039
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. MARTINE J BARON LCSW

Provider Business Mailing Address
First Line	:	110 W END AVE
Second Line	:	21D
City	:	NEW YORK
State	:	NY
Zip	:	10023-6340
Country	:	US
Telephone Number	:	917-214-1227
Fax Number	:	212-496-6186

Provider Business Practice Location Address
First Line	:	110 W END AVE
Second Line	:	21D
City	:	NEW YORK
State	:	NY
Zip	:	10023-6340
Country	:	US
Telephone Number	:	917-214-1227
Fax Number	:	212-496-6186

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

Provider Enumeration Date	:	06/16/2009
Last Update Date	:	06/16/2009

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