MEDICARE: DR. PHYLLIS TOMPKINS LCSW, PH.D

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	1041C0700X	Clinical Social Worker	RO45875-1	NY

General Provider Information

NPI Number	:	1013935824
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. PHYLLIS TOMPKINS LCSW, PH.D

Provider Business Mailing Address
First Line	:	308 E 79TH ST
Second Line	:	3A
City	:	NEW YORK
State	:	NY
Zip	:	10075-0906
Country	:	US
Telephone Number	:	917-741-1120
Fax Number	:

Provider Business Practice Location Address
First Line	:	1225 PARK AVE
Second Line	:	1A
City	:	NEW YORK
State	:	NY
Zip	:	10128-1758
Country	:	US
Telephone Number	:	917-741-1120
Fax Number	:

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

Provider Enumeration Date	:	07/18/2006
Last Update Date	:	02/22/2011

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