MEDICARE: ROBIN BRADY MEAD 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	R055961-2	NY
2	1041C0700X	Clinical Social Worker	R055961	NY

General Provider Information

NPI Number	:	1386615847
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ROBIN BRADY MEAD LCSW

Provider Business Mailing Address
First Line	:	3 WASHINGTON SQ VLG
Second Line	:	APT 11M
City	:	NEW YORK
State	:	NY
Zip	:	10012-1806
Country	:	US
Telephone Number	:	917-817-8021
Fax Number	:

Provider Business Practice Location Address
First Line	:	270 LAFAYETTE ST
Second Line	:	SUITE 804
City	:	NEW YORK
State	:	NY
Zip	:	10012-2347
Country	:	US
Telephone Number	:	917-817-8021
Fax Number	:

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

Provider Enumeration Date	:	01/31/2006
Last Update Date	:	11/20/2015

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