MEDICARE: MS. MARTHA HOSANG 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	101YM0800X	Mental Health Counselor

General Provider Information

NPI Number	:	1033346895
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. MARTHA HOSANG LCSW

Provider Business Mailing Address
First Line	:	609 COLUMBUS AVE
Second Line	:	16H
City	:	NEW YORK
State	:	NY
Zip	:	10024-1408
Country	:	US
Telephone Number	:	917-445-6260
Fax Number	:

Provider Business Practice Location Address
First Line	:	609 COLUMBUS AVE.
Second Line	:	16H
City	:	NEW YORK
State	:	NY
Zip	:	10024-1462
Country	:	US
Telephone Number	:	917-445-6260
Fax Number	:

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

Provider Enumeration Date	:	06/18/2009
Last Update Date	:	06/18/2009

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