MEDICARE: MS. DAWN MANISCALCO L.C.S.W.

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

General Provider Information

NPI Number	:	1144468869
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. DAWN MANISCALCO L.C.S.W.

Provider Business Mailing Address
First Line	:	555 KAPPOCK ST APT 2B
Second Line	:
City	:	BRONX
State	:	NY
Zip	:	10463-6425
Country	:	US
Telephone Number	:	718-884-0108
Fax Number	:

Provider Business Practice Location Address
First Line	:	555 KAPPOCK ST APT 2B
Second Line	:
City	:	BRONX
State	:	NY
Zip	:	10463-6425
Country	:	US
Telephone Number	:	718-884-0108
Fax Number	:

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

Provider Enumeration Date	:	02/03/2009
Last Update Date	:	02/03/2009

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