MEDICARE: LOVE CHILD, LCSW P.C

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	P051882-1	NY

General Provider Information

NPI Number	:	1033472196
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LOVE CHILD, LCSW P.C

Provider Business Mailing Address
First Line	:	3309 AVENUE J
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11210-4117
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3309 AVENUE J
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11210-4117
Country	:	US
Telephone Number	:	347-251-4891
Fax Number	:

Authorized Official
Title or Position	:	SOCIAL WORKER
Name	:	MELISSA HILLARY GRAY
Credential	:
Telephone Number	:	347-251-4891

Provider Enumeration Date	:	06/22/2012
Last Update Date	:	06/22/2012

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