MEDICARE: HELPING OUR PEOPLE EXCEL COMMUNITY SOCIAL WORK INITIATIVE, P.C

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	R05888-3	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1376565283
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HELPING OUR PEOPLE EXCEL COMMUNITY SOCIAL WORK INITIATIVE, P.C

Provider Business Mailing Address
First Line	:	PO BOX 360470
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11236-0470
Country	:	US
Telephone Number	:	718-922-4721
Fax Number	:	718-922-6011

Provider Business Practice Location Address
First Line	:	1411 LINDEN BLVD APT 5F
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11212-5143
Country	:	US
Telephone Number	:	718-922-4721
Fax Number	:	718-922-6011

Authorized Official
Title or Position	:	CEO/THERAPIST
Name	:	MISS TANYA SHERISE ODUMS
Credential	:	LCSW
Telephone Number	:	718-922-4721

Provider Enumeration Date	:	07/23/2006
Last Update Date	:	08/22/2020

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