MEDICARE: MRS. MAUREEN A BORKOWSKI LCSW-R, CASAC

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	101YA0400X	Addiction (Substance Use Disorder) Counselor	4097	NY
2	1041C0700X	Clinical Social Worker	R071800-1	NY

General Provider Information

NPI Number	:	1962736546
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. MAUREEN A BORKOWSKI LCSW-R, CASAC

Provider Business Mailing Address
First Line	:	26 TAPPAN AVE
Second Line	:
City	:	ISLIP
State	:	NY
Zip	:	11751-4106
Country	:	US
Telephone Number	:	631-581-6846
Fax Number	:	631-581-1919

Provider Business Practice Location Address
First Line	:	6800 JERICHO TPKE
Second Line	:	SUITE 122W
City	:	SYOSSET
State	:	NY
Zip	:	11791-4436
Country	:	US
Telephone Number	:	631-235-3410
Fax Number	:

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

Provider Enumeration Date	:	09/29/2009
Last Update Date	:	09/29/2009

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