MEDICARE: MS. NAOMI WILMA BRUSSEL 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	015050	NY

General Provider Information

NPI Number	:	1376594184
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. NAOMI WILMA BRUSSEL LCSW

Provider Business Mailing Address
First Line	:	222 114TH ST B
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11215
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	227 MADISON STREET ROOM 107
Second Line	:	GOUVERNEUR HEALTHCARE SERVICES
City	:	NEW YORK
State	:	NY
Zip	:	10002
Country	:	US
Telephone Number	:	212-238-7498
Fax Number	:	212-238-8189

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

Provider Enumeration Date	:	05/15/2006
Last Update Date	:	07/08/2007

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