MEDICARE: MR. JOHN F. REDDY JR. SOCIAL WORKER

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YA0400X	Addiction (Substance Use Disorder) Counselor	R046950	NY
2	1041C0700X	Clinical Social Worker	R046950	NY

General Provider Information

NPI Number	:	1013230572
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. JOHN F. REDDY JR. SOCIAL WORKER

Provider Business Mailing Address
First Line	:	331 WEST AVENUE
Second Line	:
City	:	SARATOGA SPRINGS
State	:	NY
Zip	:	12866
Country	:	US
Telephone Number	:	518-583-0306
Fax Number	:	518-583-0176

Provider Business Practice Location Address
First Line	:	331 WEST AVE
Second Line	:
City	:	SARATOGA SPRINGS
State	:	NY
Zip	:	12866-5906
Country	:	US
Telephone Number	:	518-583-0306
Fax Number	:	518-583-0176

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/11/2010
Last Update Date	:	03/11/2010

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