MEDICARE: AMY L EDELSTEIN 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	44SC05813300	NJ

General Provider Information

NPI Number	:	1992137855
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AMY L EDELSTEIN LCSW

Provider Business Mailing Address
First Line	:	516 BLOOMFIELD AVE STE 2
Second Line	:
City	:	MONTCLAIR
State	:	NJ
Zip	:	07042-3416
Country	:	US
Telephone Number	:	201-981-9318
Fax Number	:

Provider Business Practice Location Address
First Line	:	516 BLOOMFIELD AVE STE 2
Second Line	:
City	:	MONTCLAIR
State	:	NJ
Zip	:	07042-3416
Country	:	US
Telephone Number	:	201-981-9318
Fax Number	:

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

Provider Enumeration Date	:	08/02/2013
Last Update Date	:	10/31/2019

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