MEDICARE: MS. LESLIE JILL KRAUT 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	72092376	NY

General Provider Information

NPI Number	:	1174984249
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. LESLIE JILL KRAUT LMSW

Provider Business Mailing Address
First Line	:	315 WALT WHITMAN RD STE 209
Second Line	:
City	:	HUNTINGTON STATION
State	:	NY
Zip	:	11746-4112
Country	:	US
Telephone Number	:	617-504-7853
Fax Number	:

Provider Business Practice Location Address
First Line	:	315 WALT WHITMAN RD
Second Line	:	SUITE 209
City	:	HUNTINGTON STATION
State	:	NY
Zip	:	11746-4112
Country	:	US
Telephone Number	:	617-504-7853
Fax Number	:

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

Provider Enumeration Date	:	03/16/2016
Last Update Date	:	03/16/2016

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