MEDICARE: RENEE MAYER COHALL 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	R036051-1	NY

General Provider Information

NPI Number	:	1043408032
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RENEE MAYER COHALL LCSW

Provider Business Mailing Address
First Line	:	181 SPROUT BROOK RD
Second Line	:
City	:	CORTLANDT MANOR
State	:	NY
Zip	:	10567-7332
Country	:	US
Telephone Number	:	914-739-1288
Fax Number	:

Provider Business Practice Location Address
First Line	:	2043 SAW MILL RIVER RD
Second Line	:
City	:	YORKTOWN HEIGHTS
State	:	NY
Zip	:	10598-4186
Country	:	US
Telephone Number	:	914-382-3104
Fax Number	:

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

Provider Enumeration Date	:	10/04/2007
Last Update Date	:	10/04/2007

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