MEDICARE: KAREN LYNN MRUK 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	104100000X	Social Worker	R050677-1	NY

General Provider Information

NPI Number	:	1235343021
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KAREN LYNN MRUK LCSW

Provider Business Mailing Address
First Line	:	74 2ND PL APT 5B
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11231-4143
Country	:	US
Telephone Number	:	718-643-4828
Fax Number	:

Provider Business Practice Location Address
First Line	:	24 E 12TH ST RM 505
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10003-4560
Country	:	US
Telephone Number	:	212-337-1138
Fax Number	:

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

Provider Enumeration Date	:	05/10/2007
Last Update Date	:	07/08/2007

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