MEDICARE: LYNNE MAUSS LCSWR

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	R058636-1	NY

General Provider Information

NPI Number	:	1063883148
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LYNNE MAUSS LCSWR

Provider Business Mailing Address
First Line	:	23 BREWSTER ST
Second Line	:
City	:	HUNTINGTON STATION
State	:	NY
Zip	:	11746-2504
Country	:	US
Telephone Number	:	631-425-0909
Fax Number	:

Provider Business Practice Location Address
First Line	:	23 BREWSTER ST
Second Line	:
City	:	HUNTINGTON STATION
State	:	NY
Zip	:	11746-2504
Country	:	US
Telephone Number	:	631-425-0909
Fax Number	:

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

Provider Enumeration Date	:	10/14/2015
Last Update Date	:	10/14/2015

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