MEDICARE: MS. MIDGE M LUNSFORD M.S.W.

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	R029548-1	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1056560	OTHER	NY	BEACON HEALTH STRATEGIES
2	163907	OTHER	NY	VALUEOPTIONS
3	7480145	OTHER	NY	GHI

General Provider Information

NPI Number	:	1265594386
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. MIDGE M LUNSFORD M.S.W.

Provider Business Mailing Address
First Line	:	3410 DE REIMER AVE
Second Line	:	SUITE 7A
City	:	BRONX
State	:	NY
Zip	:	10475-1518
Country	:	US
Telephone Number	:	718-320-9203
Fax Number	:	718-320-9203

Provider Business Practice Location Address
First Line	:	3919 DYRE AVE
Second Line	:
City	:	BRONX
State	:	NY
Zip	:	10466-2507
Country	:	US
Telephone Number	:	718-974-6622
Fax Number	:	718-320-9203

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

Provider Enumeration Date	:	12/14/2006
Last Update Date	:	07/08/2007

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