MEDICARE: MS. COLLEEN MICHELLE GARVEY 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	RO48618-1	NY

General Provider Information

NPI Number	:	1053435107
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. COLLEEN MICHELLE GARVEY LCSW

Provider Business Mailing Address
First Line	:	2775 ISLAND CHANNEL RD
Second Line	:
City	:	SEAFORD
State	:	NY
Zip	:	11783-3324
Country	:	US
Telephone Number	:	516-889-0080
Fax Number	:	516-785-4289

Provider Business Practice Location Address
First Line	:	26 E PARK AVE
Second Line	:	SUITE 300
City	:	LONG BEACH
State	:	NY
Zip	:	11561-3595
Country	:	US
Telephone Number	:	516-889-0080
Fax Number	:	516-785-4289

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

Provider Enumeration Date	:	03/16/2007
Last Update Date	:	07/08/2007

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