MEDICARE: MADELYN KRASSNER LISW

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	171M00000X	Case Manager/Care Coordinator	I-3496	NM

General Provider Information

NPI Number	:	1306150024
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MADELYN KRASSNER LISW

Provider Business Mailing Address
First Line	:	605 LETRADO ST
Second Line	:
City	:	SANTA FE
State	:	NM
Zip	:	87505-4146
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	605 LETRADO ST
Second Line	:
City	:	SANTA FE
State	:	NM
Zip	:	87505-4146
Country	:	US
Telephone Number	:	505-470-1775
Fax Number	:	505-476-2694

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

Provider Enumeration Date	:	08/05/2010
Last Update Date	:	08/05/2010

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1003944471 — MS. LAURIE JAYNE SPIEGEL CNP
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1275855645 — SUSAN B MERRILL MSW, LISW
Practice Location Address:

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1275848632 — MRS. BETTY JEAN SHINAS LISW
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