MEDICARE: MR. JAMES LOUIS FLOURNOY 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	069693	NY

General Provider Information

NPI Number	:	1073630802
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. JAMES LOUIS FLOURNOY LCSW

Provider Business Mailing Address
First Line	:	1150 OSSIPEE RD
Second Line	:
City	:	WEST HEMPSTEAD
State	:	NY
Zip	:	11552-3910
Country	:	US
Telephone Number	:	516-536-1835
Fax Number	:

Provider Business Practice Location Address
First Line	:	14728 HILLSIDE AVE
Second Line	:
City	:	JAMAICA
State	:	NY
Zip	:	11435-3329
Country	:	US
Telephone Number	:	917-940-7087
Fax Number	:

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

Provider Enumeration Date	:	03/25/2007
Last Update Date	:	07/08/2007

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