MEDICARE: CATHARINA MARIA KLEUSKENS 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	101Y00000X	Counselor	00070679	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	:	1194805911
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CATHARINA MARIA KLEUSKENS LMSW

Provider Business Mailing Address
First Line	:	31 FLOWER LANE
Second Line	:
City	:	GREAT NECK
State	:	NY
Zip	:	11024
Country	:	US
Telephone Number	:	917-657-7780
Fax Number	:	718-845-9380

Provider Business Practice Location Address
First Line	:	31 FLOWER LN
Second Line	:
City	:	GREAT NECK
State	:	NY
Zip	:	11024-1614
Country	:	US
Telephone Number	:	516-487-5935
Fax Number	:

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

Provider Enumeration Date	:	10/16/2006
Last Update Date	:	07/08/2007

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