MEDICARE: ALVEEN ASHBEE BREGAUDIT LMSW

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	103401	NY

General Provider Information

NPI Number	:	1174098222
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALVEEN ASHBEE BREGAUDIT LMSW

Provider Business Mailing Address
First Line	:	554 W 148TH ST APT 51
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10031-4137
Country	:	US
Telephone Number	:	315-491-6862
Fax Number	:

Provider Business Practice Location Address
First Line	:	484 ROCKAWAY AVE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11212-5636
Country	:	US
Telephone Number	:	718-495-6700
Fax Number	:	718-485-4018

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

Provider Enumeration Date	:	10/04/2018
Last Update Date	:	10/04/2018

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