MEDICARE: MRS. J. VICTORIA LASZLO LCSW, LCADC

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	44SC05165200	NJ

General Provider Information

NPI Number	:	1366587248
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. J. VICTORIA LASZLO LCSW, LCADC

Provider Business Mailing Address
First Line	:	171 MAIN ST
Second Line	:
City	:	SOUTH RIVER
State	:	NJ
Zip	:	08882-1500
Country	:	US
Telephone Number	:	732-794-3629
Fax Number	:	732-390-9298

Provider Business Practice Location Address
First Line	:	171 MAIN ST
Second Line	:
City	:	SOUTH RIVER
State	:	NJ
Zip	:	08882-1500
Country	:	US
Telephone Number	:	732-794-3629
Fax Number	:	732-390-9298

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

Provider Enumeration Date	:	02/20/2007
Last Update Date	:	07/08/2007

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