MEDICARE: SUZANNE LIVOLSI L.M.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	1041S0200X	School Social Worker	063556-1	NY

General Provider Information

NPI Number	:	1083838189
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SUZANNE LIVOLSI L.M.S.W.

Provider Business Mailing Address
First Line	:	17 ATMORE PL
Second Line	:
City	:	STATEN ISLAND
State	:	NY
Zip	:	10306-1161
Country	:	US
Telephone Number	:	718-980-1209
Fax Number	:

Provider Business Practice Location Address
First Line	:	3974 AMBOY RD
Second Line	:	3RD FL
City	:	STATEN ISLAND
State	:	NY
Zip	:	10308-2414
Country	:	US
Telephone Number	:	718-984-5050
Fax Number	:	718-984-5165

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

Provider Enumeration Date	:	04/12/2007
Last Update Date	:	07/08/2007

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