MEDICARE: EILEEN DWYER 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	PR015469-1	NY

General Provider Information

NPI Number	:	1346319597
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EILEEN DWYER LCSW

Provider Business Mailing Address
First Line	:	21536 48TH AVE
Second Line	:
City	:	OAKLAND GARDENS
State	:	NY
Zip	:	11364-1314
Country	:	US
Telephone Number	:	718-279-3390
Fax Number	:	718-565-9437

Provider Business Practice Location Address
First Line	:	21536 48TH AVE
Second Line	:
City	:	OAKLAND GARDENS
State	:	NY
Zip	:	11364-1314
Country	:	US
Telephone Number	:	718-279-3390
Fax Number	:	718-565-9437

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

Provider Enumeration Date	:	11/06/2006
Last Update Date	:	07/08/2007

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