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NPI Code Detail

MEDICARE: MS. MICHELE F SUDANO LCSW

MEDICARE: MS. MICHELE F SUDANO 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
11041C0700XClinical Social Worker057437NY

General Provider Information

NPI Number : 1396956033
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. MICHELE F SUDANO LCSW
Provider Business Mailing Address
First Line : 123 8TH AVE
Second Line : 4F
City : BROOKLYN
State : NY
Zip : 11215-1708
Country : US
Telephone Number : 917-282-1475
Fax Number :
Provider Business Practice Location Address
First Line : 300 FLATBUSH AVE
Second Line :
City : BROOKLYN
State : NY
Zip : 11217-2812
Country : US
Telephone Number : 718-622-2000
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/24/2007
Last Update Date : 07/08/2007

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