MEDICARE: MS. ELEANOR POPE 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	077124	NY

General Provider Information

NPI Number	:	1316103534
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. ELEANOR POPE LCSW

Provider Business Mailing Address
First Line	:	1841 PARK AVE
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10035-1316
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4470 21ST ST # 3293
Second Line	:
City	:	LONG ISLAND CITY
State	:	NY
Zip	:	11101-5114
Country	:	US
Telephone Number	:	201-305-0772
Fax Number	:

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

Provider Enumeration Date	:	08/07/2008
Last Update Date	:	10/25/2022

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