MEDICARE: CESAR AUGUSTO LOARCA 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	069754	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	069754	OTHER	NY	DEPARTMENT OF EDUCATION

General Provider Information

NPI Number	:	1053336875
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CESAR AUGUSTO LOARCA LCSW

Provider Business Mailing Address
First Line	:	PO BOX 340
Second Line	:
City	:	SWAN LAKE
State	:	NY
Zip	:	12783-0340
Country	:	US
Telephone Number	:	845-292-6880
Fax Number	:	845-292-4652

Provider Business Practice Location Address
First Line	:	4404 STATE ROUTE 55
Second Line	:
City	:	SWAN LAKE
State	:	NY
Zip	:	12283
Country	:	US
Telephone Number	:	845-292-6880
Fax Number	:	845-292-4652

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

Provider Enumeration Date	:	07/13/2006
Last Update Date	:	07/08/2007

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