MEDICARE: MELVIN JULIUS OWENS JR. 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	72-084593	NY
2	1041C0700X	Clinical Social Worker	73 084286	NY

General Provider Information

NPI Number	:	1255601969
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MELVIN JULIUS OWENS JR. LCSW

Provider Business Mailing Address
First Line	:	127 W 30TH ST FL 9
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10001-3406
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	127 W 30TH ST FL 9
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10001-3406
Country	:	US
Telephone Number	:	646-389-5094
Fax Number	:

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

Provider Enumeration Date	:	01/11/2012
Last Update Date	:	01/12/2024

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