MEDICARE: MS. MARIANNE BURY MSW, 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	R014000-1	NY

General Provider Information

NPI Number	:	1164525119
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. MARIANNE BURY MSW, LCSW

Provider Business Mailing Address
First Line	:	489 LYNN ST
Second Line	:
City	:	STATEN ISLAND
State	:	NY
Zip	:	10306-5314
Country	:	US
Telephone Number	:	718-667-1496
Fax Number	:	718-667-1496

Provider Business Practice Location Address
First Line	:	3915 HYLAN BLVD
Second Line	:
City	:	STATEN ISLAND
State	:	NY
Zip	:	10308-3425
Country	:	US
Telephone Number	:	718-948-7800
Fax Number	:	718-948-1733

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

Provider Enumeration Date	:	09/06/2006
Last Update Date	:	07/08/2007

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