MEDICARE: MRS. MADELEINE SHAIR 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

General Provider Information

NPI Number	:	1063652691
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. MADELEINE SHAIR LCSW

Provider Business Mailing Address
First Line	:	7 MINOR CT
Second Line	:
City	:	WEST NYACK
State	:	NY
Zip	:	10994-1110
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3380 RESERVOIR OVAL
Second Line	:	SCHOOL BASED HEALTH CENTER
City	:	BRONX
State	:	NY
Zip	:	10467-3101
Country	:	US
Telephone Number	:	718-696-4060
Fax Number	:

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

Provider Enumeration Date	:	02/23/2009
Last Update Date	:	09/25/2012

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