MEDICARE: KENNETH PADRON 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	104100000X	Social Worker	44SL05327100	NJ
2	1041C0700X	Clinical Social Worker	078371-1	NY

General Provider Information

NPI Number	:	1043384605
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KENNETH PADRON LCSW

Provider Business Mailing Address
First Line	:	57 BAY ST FL 3
Second Line	:
City	:	STATEN ISLAND
State	:	NY
Zip	:	10301-2510
Country	:	US
Telephone Number	:	718-681-8700
Fax Number	:

Provider Business Practice Location Address
First Line	:	57 BAY ST FL 3
Second Line	:
City	:	STATEN ISLAND
State	:	NY
Zip	:	10301-2510
Country	:	US
Telephone Number	:	718-681-8700
Fax Number	:

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

Provider Enumeration Date	:	11/17/2006
Last Update Date	:	09/02/2019

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Directions to “ KENNETH PADRON LCSW” Practice Location

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