MEDICARE: BARBARA CHITKARA 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	071360-1	NY

General Provider Information

NPI Number	:	1326091307
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BARBARA CHITKARA LCSW

Provider Business Mailing Address
First Line	:	PO BOX 22036
Second Line	:
City	:	ALBANY
State	:	NY
Zip	:	12201-2036
Country	:	US
Telephone Number	:	631-854-1222
Fax Number	:	631-854-1226

Provider Business Practice Location Address
First Line	:	365 E MAIN ST
Second Line	:
City	:	PATCHOGUE
State	:	NY
Zip	:	11772-3145
Country	:	US
Telephone Number	:	631-854-1222
Fax Number	:	631-854-1226

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

Provider Enumeration Date	:	05/18/2006
Last Update Date	:	07/08/2007

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