MEDICARE: MRS. MICHELLE RECLA 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	1041C0700X	Clinical Social Worker	068153-1	NY

General Provider Information

NPI Number	:	1184997066
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. MICHELLE RECLA LMSW

Provider Business Mailing Address
First Line	:	344 PROSPECT AVE
Second Line	:	APT. #4A
City	:	HACKENSACK
State	:	NJ
Zip	:	07601-2601
Country	:	US
Telephone Number	:	347-210-5606
Fax Number	:

Provider Business Practice Location Address
First Line	:	424 E 147TH ST
Second Line	:	4TH FLOOR
City	:	BRONX
State	:	NY
Zip	:	10455-4104
Country	:	US
Telephone Number	:	646-393-9680
Fax Number	:

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

Provider Enumeration Date	:	02/22/2012
Last Update Date	:	02/22/2012

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