MEDICARE: AMY SOCOLOW 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	R052769-1	NY

General Provider Information

NPI Number	:	1316025422
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AMY SOCOLOW LCSW

Provider Business Mailing Address
First Line	:	130 8TH AVE
Second Line	:	6H
City	:	BROOKLYN
State	:	NY
Zip	:	11215-1766
Country	:	US
Telephone Number	:	718-638-0854
Fax Number	:

Provider Business Practice Location Address
First Line	:	853 BROADWAY
Second Line	:	SUITE 1511
City	:	NEW YORK
State	:	NY
Zip	:	10003-4703
Country	:	US
Telephone Number	:	917-922-1504
Fax Number	:

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

Provider Enumeration Date	:	11/02/2006
Last Update Date	:	07/08/2007

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