MEDICARE: LORNA JANE LICSW

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	094621	NY
2	1041C0700X	Clinical Social Worker	1032141	MA
3	1041C0700X	Clinical Social Worker	LC22356	ME

General Provider Information

NPI Number	:	1104974252
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LORNA JANE LICSW

Provider Business Mailing Address
First Line	:	5203 CENTER BLVD APT 2706
Second Line	:
City	:	LONG ISLAND CITY
State	:	NY
Zip	:	11101-6672
Country	:	US
Telephone Number	:	617-365-3757
Fax Number	:	718-786-8714

Provider Business Practice Location Address
First Line	:	5203 CENTER BLVD APT 2706
Second Line	:
City	:	LONG ISLAND CITY
State	:	NY
Zip	:	11101-6672
Country	:	US
Telephone Number	:	173-653-8376
Fax Number	:	187-868-7147

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

Provider Enumeration Date	:	01/08/2007
Last Update Date	:	12/27/2023

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Directions to “ LORNA JANE LICSW” Practice Location

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