=====================================================
General NPI Number Information
=====================================================
NPI Number | 1801014071
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | CARMEN MERCEDES MAYER L.M.S.W.
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/23/2007
-----------------------------------------------------
Last Update Date | 07/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 30 BAY ST
-----------------------------------------------------
City | STATEN ISLAND
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10301-2512
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 718-818-9203
-----------------------------------------------------
Fax | 718-818-9206
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 181 ROOSEVELT AVE
-----------------------------------------------------
City | STATEN ISLAND
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10314-4152
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 718-370-2401
-----------------------------------------------------
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 | 072311-1
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------