MEDICARE: ANUSH AZDUNI 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	104100000X	Social Worker	167440-1	NY
2	1041C0700X	Clinical Social Worker	078947-1	NY

General Provider Information

NPI Number	:	1134272461
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANUSH AZDUNI LCSW

Provider Business Mailing Address
First Line	:	45 TEHAMA ST
Second Line	:	4L
City	:	BROOKLYN
State	:	NY
Zip	:	11218-2150
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2128 ROCKAWAY PKWY
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11236-5802
Country	:	US
Telephone Number	:	718-272-3300
Fax Number	:	718-927-1801

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

Provider Enumeration Date	:	01/19/2007
Last Update Date	:	07/20/2012

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Directions to “ ANUSH AZDUNI LCSW” Practice Location

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