=====================================================
General NPI Number Information
=====================================================
NPI Number | 1255452504
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | BARBARA B MARKOWITZ LCSW
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/03/2007
-----------------------------------------------------
Last Update Date | 08/22/2012
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 124 MERRICK AVE
-----------------------------------------------------
City | MERRICK
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11566-3434
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 516-377-4054
-----------------------------------------------------
Fax | 516-377-4054
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3391 SEAWANE DR
-----------------------------------------------------
City | MERRICK
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11566-5545
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 516-377-4054
-----------------------------------------------------
Fax | 516-377-4054
-----------------------------------------------------
=====================================================
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 | R019597
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------