MEDICARE: MS. CAROL SPERO 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	PR0078431	NY

General Provider Information

NPI Number	:	1063633956
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. CAROL SPERO LCSW

Provider Business Mailing Address
First Line	:	1725 YORK AVE
Second Line	:	APT 8D
City	:	NEW YORK CITY
State	:	NY
Zip	:	10128-7809
Country	:	US
Telephone Number	:	212-746-3804
Fax Number	:	212-746-6168

Provider Business Practice Location Address
First Line	:	430 EAST 86TH STREET
Second Line	:	SUITE 1F
City	:	NEW YORK CITY
State	:	NY
Zip	:	10028
Country	:	US
Telephone Number	:	212-746-3804
Fax Number	:

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

Provider Enumeration Date	:	05/01/2007
Last Update Date	:	07/08/2007

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