MEDICARE: DAVID WYNER 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	1041C0700X	Clinical Social Worker	R018824-1	NY

General Provider Information

NPI Number	:	1275744401
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DAVID WYNER LCSW

Provider Business Mailing Address
First Line	:	3103 FAIRFIELD AVE
Second Line	:
City	:	BRONX
State	:	NY
Zip	:	10463-3242
Country	:	US
Telephone Number	:	718-884-9574
Fax Number	:	718-796-5900

Provider Business Practice Location Address
First Line	:	3103 FAIRFIELD AVE
Second Line	:
City	:	BRONX
State	:	NY
Zip	:	10463-3242
Country	:	US
Telephone Number	:	718-884-9574
Fax Number	:	718-796-5900

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

Provider Enumeration Date	:	05/28/2007
Last Update Date	:	07/08/2007

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