MEDICARE: JOAN DIANE WINOGRAD L.C.S.W,

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	RO27978-1	NY

General Provider Information

NPI Number	:	1063547487
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOAN DIANE WINOGRAD L.C.S.W,

Provider Business Mailing Address
First Line	:	607 W END AVE
Second Line	:	APT. 10A
City	:	NEW YORK
State	:	NY
Zip	:	10024-1606
Country	:	US
Telephone Number	:	212-362-4003
Fax Number	:	212-362-4035

Provider Business Practice Location Address
First Line	:	140 RIVERSIDE DR
Second Line	:	SUITE 1A
City	:	NEW YORK
State	:	NY
Zip	:	10024-2605
Country	:	US
Telephone Number	:	212-362-4003
Fax Number	:	212-362-4035

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

Provider Enumeration Date	:	02/23/2007
Last Update Date	:	07/08/2007

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