MEDICARE: STACY PLAYER

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	079567-1	NY

General Provider Information

NPI Number	:	1215226501
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	STACY PLAYER

Provider Business Mailing Address
First Line	:	7164 168TH ST
Second Line	:
City	:	FLUSHING
State	:	NY
Zip	:	11365-3242
Country	:	US
Telephone Number	:	718-591-8100
Fax Number	:	718-969-2941

Provider Business Practice Location Address
First Line	:	462 W OLIVE ST
Second Line	:
City	:	LONG BEACH
State	:	NY
Zip	:	11561-3128
Country	:	US
Telephone Number	:	516-567-4631
Fax Number	:

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

Provider Enumeration Date	:	04/07/2011
Last Update Date	:	04/07/2011

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Directions to “ STACY PLAYER ” Practice Location

Language	Start Address	Practice Location

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