=====================================================
General NPI Number Information
=====================================================
NPI Number | 1417223405
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MARGARET L ACERRA LCSW
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/24/2012
-----------------------------------------------------
Last Update Date | 08/05/2013
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 98120 QUEENS BLVD
-----------------------------------------------------
City | REGO PARK
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11374-4357
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 718-830-0846
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 10 LATTINGTOWN RIDGE CT POBOX 503
-----------------------------------------------------
City | LOCUST VALLEY
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11560-1302
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 516-606-9299
-----------------------------------------------------
Fax | 516-759-4029
-----------------------------------------------------
=====================================================
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 | 020999-1
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 106H00000X
-----------------------------------------------------
Taxonomy Name | Marriage & Family Therapist
-----------------------------------------------------
License Number | 020999-1
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------