MEDICARE: MS. LILI NICOLE GLAUBER LMSW

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	079755-1	NY

General Provider Information

NPI Number	:	1124343207
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. LILI NICOLE GLAUBER LMSW

Provider Business Mailing Address
First Line	:	2128 ROCKAWAY PARKWAY
Second Line	:	INSTITUTE FOR COMMUNITY LIVING, INC.
City	:	BROOKLYN
State	:	NY
Zip	:	11236
Country	:	US
Telephone Number	:	510-418-4556
Fax Number	:

Provider Business Practice Location Address
First Line	:	2128 ROCKAWAY PARKWAY
Second Line	:	INSTITUTE FOR COMMUNITY LIVING, INC.
City	:	BROOKLYN
State	:	NY
Zip	:	11236
Country	:	US
Telephone Number	:	510-418-4556
Fax Number	:

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

Provider Enumeration Date	:	04/01/2010
Last Update Date	:	04/01/2010

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