MEDICARE: MS. LUCY A MIRO-QUESADA 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	072978-1	NY

General Provider Information

NPI Number	:	1093924961
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. LUCY A MIRO-QUESADA LCSW

Provider Business Mailing Address
First Line	:	63109 SAUNDERS ST APT F17
Second Line	:
City	:	REGO PARK
State	:	NY
Zip	:	11374-3133
Country	:	US
Telephone Number	:	718-997-0271
Fax Number	:

Provider Business Practice Location Address
First Line	:	119 W 124TH ST
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10027-4920
Country	:	US
Telephone Number	:	212-932-2676
Fax Number	:	212-864-5087

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

Provider Enumeration Date	:	05/21/2007
Last Update Date	:	07/08/2007

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