=====================================================
General NPI Number Information
=====================================================
NPI Number | 1710253224
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | FAY M AARONSON LCSW-R
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/29/2012
-----------------------------------------------------
Last Update Date | 03/29/2012
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1355 CTY. RTE. 3
-----------------------------------------------------
City | MARGARETVILLE
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 12455-2747
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 917-861-5918
-----------------------------------------------------
Fax | 347-713-5327
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1115 EAST 36 STREET
-----------------------------------------------------
City | BROOKLYN
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11210-4822
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 718-707-1166
-----------------------------------------------------
Fax | 347-713-5327
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 104100000X
-----------------------------------------------------
Taxonomy Name | Social Worker
-----------------------------------------------------
License Number | R037992-1
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------