MEDICARE: JANET RUSHING ZOGBY LCSW-R

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	RO49932-1	NY

General Provider Information

NPI Number	:	1386841351
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JANET RUSHING ZOGBY LCSW-R

Provider Business Mailing Address
First Line	:	1 KIRKLAND AVE STE 103
Second Line	:
City	:	CLINTON
State	:	NY
Zip	:	13323-1426
Country	:	US
Telephone Number	:	315-859-1481
Fax Number	:	315-859-1481

Provider Business Practice Location Address
First Line	:	1 KIRKLAND AVE STE 103
Second Line	:
City	:	CLINTON
State	:	NY
Zip	:	13323-1426
Country	:	US
Telephone Number	:	315-859-1481
Fax Number	:	315-859-1481

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

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

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