MEDICARE: LETS TALK WELLNESS CENTER INC

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	101YA0400X	Addiction (Substance Use Disorder) Counselor
2	101YM0800X	Mental Health Counselor
3	104100000X	Social Worker
4	1041C0700X	Clinical Social Worker

General Provider Information

NPI Number	:	1023350527
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LETS TALK WELLNESS CENTER INC

Provider Business Mailing Address
First Line	:	14728 HILLSIDE AVE
Second Line	:	2ND FLOOR
City	:	JAMAICA
State	:	NY
Zip	:	11435-3329
Country	:	US
Telephone Number	:	914-407-2707
Fax Number	:

Provider Business Practice Location Address
First Line	:	14728 HILLSIDE AVE
Second Line	:	2ND FLOOR
City	:	JAMAICA
State	:	NY
Zip	:	11435-3329
Country	:	US
Telephone Number	:	914-407-2707
Fax Number	:

Authorized Official
Title or Position	:	DIRECTOR
Name	:	CELINE BOBB-INNISS
Credential	:
Telephone Number	:	718-916-3359

Provider Enumeration Date	:	03/22/2013
Last Update Date	:	03/22/2013

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