MEDICARE: MS. MADELINE NACK 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	LCSWR015671	NY

General Provider Information

NPI Number	:	1396852315
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. MADELINE NACK LCSW

Provider Business Mailing Address
First Line	:	10 LESLIE LN
Second Line	:
City	:	HUNTINGTON
State	:	NY
Zip	:	11743-6809
Country	:	US
Telephone Number	:	631-271-4902
Fax Number	:	631-271-5076

Provider Business Practice Location Address
First Line	:	10 LESLIE LN
Second Line	:
City	:	HUNTINGTON
State	:	NY
Zip	:	11743-6809
Country	:	US
Telephone Number	:	631-271-4902
Fax Number	:	631-271-5076

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

Provider Enumeration Date	:	08/24/2006
Last Update Date	:	07/08/2007

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