=====================================================
General NPI Number Information
=====================================================
NPI Number | 1215118674
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MARYANN SALERNO QURESHI SOCIAL WORKER LCSW R
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/14/2007
-----------------------------------------------------
Last Update Date | 11/14/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 87 WOLFS LANE 3RD FLOOR
-----------------------------------------------------
City | PELHAM
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10803
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 914-484-4802
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 111 SIXTH AVE
-----------------------------------------------------
City | PELHAM
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10803
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 914-738-2960
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number | LCSWR014661
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------