MEDICARE: MARIANNE WICKEL SCHLOSS 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	R030781	NY

General Provider Information

NPI Number	:	1386946416
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARIANNE WICKEL SCHLOSS LCSW

Provider Business Mailing Address
First Line	:	220 MADISON AVE
Second Line	:	APT 11B
City	:	NEW YORK
State	:	NY
Zip	:	10016-3422
Country	:	US
Telephone Number	:	212-725-7244
Fax Number	:

Provider Business Practice Location Address
First Line	:	220 MADISON AVE
Second Line	:	APT 11B
City	:	NEW YORK
State	:	NY
Zip	:	10016-3422
Country	:	US
Telephone Number	:	212-725-7244
Fax Number	:

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

Provider Enumeration Date	:	11/22/2010
Last Update Date	:	11/22/2010

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