MEDICARE: MR. FREDERICK A AIESE LCSW

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	R-058615	NY

General Provider Information

NPI Number	:	1033182852
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. FREDERICK A AIESE LCSW

Provider Business Mailing Address
First Line	:	3171 WHITNEY AVE
Second Line	:	#1F
City	:	BROOKLYN
State	:	NY
Zip	:	11229-5900
Country	:	US
Telephone Number	:	718-755-4450
Fax Number	:	718-934-7488

Provider Business Practice Location Address
First Line	:	80 5TH AVE
Second Line	:	SUITE 903A
City	:	NEW YORK
State	:	NY
Zip	:	10011-8002
Country	:	US
Telephone Number	:	718-755-4450
Fax Number	:	718-934-7488

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

Provider Enumeration Date	:	02/10/2006
Last Update Date	:	07/08/2007

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