MEDICARE: MS. RACHAEL SHAPIRO MSW

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	054565	NY

General Provider Information

NPI Number	:	1225107147
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. RACHAEL SHAPIRO MSW

Provider Business Mailing Address
First Line	:	211 RACHEL CARSON WAY
Second Line	:
City	:	ITHACA
State	:	NY
Zip	:	14850-8402
Country	:	US
Telephone Number	:	607-275-0249
Fax Number	:	607-273-5818

Provider Business Practice Location Address
First Line	:	211 RACHEL CARSON WAY
Second Line	:
City	:	ITHACA
State	:	NY
Zip	:	14850-8402
Country	:	US
Telephone Number	:	607-275-0249
Fax Number	:	607-273-5818

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

Provider Enumeration Date	:	11/07/2006
Last Update Date	:	07/08/2007

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