MEDICARE: MS. ALICE JOAN ANDERSEN 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	RO400381	NY

General Provider Information

NPI Number	:	1215094313
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. ALICE JOAN ANDERSEN LCSW

Provider Business Mailing Address
First Line	:	298 RED MAPLE DR S
Second Line	:
City	:	WANTAGH
State	:	NY
Zip	:	11793-1507
Country	:	US
Telephone Number	:	516-520-2962
Fax Number	:	516-908-3621

Provider Business Practice Location Address
First Line	:	124 MERRICK AVE
Second Line	:
City	:	MERRICK
State	:	NY
Zip	:	11566-3434
Country	:	US
Telephone Number	:	516-520-2962
Fax Number	:

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

Provider Enumeration Date	:	01/02/2007
Last Update Date	:	07/08/2007

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