MEDICARE: MS. JUDY BERNSTEIN GOTTHOFFER

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	SW8411	FL
2	1041C0700X	Clinical Social Worker	RO36687-1	NY

General Provider Information

NPI Number	:	1356480735
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. JUDY BERNSTEIN GOTTHOFFER

Provider Business Mailing Address
First Line	:	801 N OCEAN BLVD
Second Line	:	#704
City	:	POMPANO BEACH
State	:	FL
Zip	:	33062-4033
Country	:	US
Telephone Number	:	954-942-0112
Fax Number	:	954-942-0112

Provider Business Practice Location Address
First Line	:	801 N OCEAN BLVD
Second Line	:	#704
City	:	POMPANO BEACH
State	:	FL
Zip	:	33062-4033
Country	:	US
Telephone Number	:	954-942-0112
Fax Number	:	954-942-0112

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

Provider Enumeration Date	:	02/05/2007
Last Update Date	:	07/08/2007

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