MEDICARE: AREBA CASRIEL INC.

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	251S00000X	Community/Behavioral Health Agency	070978-1	NY
2	324500000X	Substance Abuse Rehabilitation Facility	070978-1	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	070978-1	OTHER	NY	LICENSED CLINICAL SOCIAL

General Provider Information

NPI Number	:	1104968692
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	AREBA CASRIEL INC.

Provider Business Mailing Address
First Line	:	850 COLUMBUS AVENUE
Second Line	:	APT 2C
City	:	NYC
State	:	NY
Zip	:	10025
Country	:	US
Telephone Number	:	646-241-2063
Fax Number	:

Provider Business Practice Location Address
First Line	:	850 COLUMBUS AVE
Second Line	:	APT 2C
City	:	NEW YORK
State	:	NY
Zip	:	10025-4560
Country	:	US
Telephone Number	:	646-241-2063
Fax Number	:

Authorized Official
Title or Position	:	CLINICAL DIRECTOR
Name	:	MS. ANGELA RITA
Credential	:	LCSW
Telephone Number	:	212-293-3000

Provider Enumeration Date	:	02/13/2007
Last Update Date	:	11/13/2007

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