MEDICARE: MS. AMANDA LEE GROPP 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	076698	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1194760926
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. AMANDA LEE GROPP LCSW

Provider Business Mailing Address
First Line	:	557 3RD ST
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11215-3047
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	514 49TH ST
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11220-2010
Country	:	US
Telephone Number	:	718-437-5274
Fax Number	:

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

Provider Enumeration Date	:	06/17/2006
Last Update Date	:	02/03/2012

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