MEDICARE: MR. ANDREW M STROMBERG 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	103T00000X	Psychologist	PR0130801	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1144387846
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. ANDREW M STROMBERG LCSW

Provider Business Mailing Address
First Line	:	26 WEST 9 ST
Second Line	:	APT 7E
City	:	NEW YORK
State	:	NY
Zip	:	10011-8532
Country	:	US
Telephone Number	:	212-475-1971
Fax Number	:	212-533-9479

Provider Business Practice Location Address
First Line	:	26 WEST 9 ST
Second Line	:	APT 7E
City	:	NEW YORK
State	:	NY
Zip	:	10011-8532
Country	:	US
Telephone Number	:	212-475-1971
Fax Number	:	212-533-9479

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

Provider Enumeration Date	:	01/02/2007
Last Update Date	:	07/08/2007

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