MEDICARE: LINDA A COSTANZA 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	5347888	NY

General Provider Information

NPI Number	:	1144313289
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LINDA A COSTANZA LCSW

Provider Business Mailing Address
First Line	:	4 7TH AVE
Second Line	:
City	:	KINGS PARK
State	:	NY
Zip	:	11754-4324
Country	:	US
Telephone Number	:	631-269-5392
Fax Number	:

Provider Business Practice Location Address
First Line	:	368 VETERANS MEMORIAL HWY
Second Line	:	MAIN LEVEL, SUITE 1
City	:	COMMACK
State	:	NY
Zip	:	11725-4322
Country	:	US
Telephone Number	:	631-269-5392
Fax Number	:

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

Provider Enumeration Date	:	10/02/2006
Last Update Date	:	07/08/2007

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