MEDICARE: DARYA SLADE 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	075907-7	NY

General Provider Information

NPI Number	:	1053556878
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DARYA SLADE LCSW

Provider Business Mailing Address
First Line	:	500 E 77TH ST APT 234
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10162-0021
Country	:	US
Telephone Number	:	516-987-9173
Fax Number	:

Provider Business Practice Location Address
First Line	:	500 E 77TH ST APT 234
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10162-0021
Country	:	US
Telephone Number	:	516-987-9173
Fax Number	:

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

Provider Enumeration Date	:	12/08/2008
Last Update Date	:	01/25/2017

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