MEDICARE: MRS. CYNTHIA MARIE PICONE LMSW

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	104100000X	Social Worker		NY

General Provider Information

NPI Number	:	1013343581
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. CYNTHIA MARIE PICONE LMSW

Provider Business Mailing Address
First Line	:	320 BROADWAY
Second Line	:
City	:	PORT JEFFERSON STATION
State	:	NY
Zip	:	11776-2508
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	320 BROADWAY
Second Line	:
City	:	PORT JEFFERSON STATION
State	:	NY
Zip	:	11776-2508
Country	:	US
Telephone Number	:	516-987-9082
Fax Number	:

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

Provider Enumeration Date	:	09/17/2013
Last Update Date	:	09/17/2013

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