MEDICARE: MIRIAM KAGAN LCAT

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	221700000X	Art Therapist	002813	NY

General Provider Information

NPI Number	:	1407514839
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MIRIAM KAGAN LCAT

Provider Business Mailing Address
First Line	:	163 TROUTMAN ST APT 1L
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11206-6317
Country	:	US
Telephone Number	:	201-663-3786
Fax Number	:

Provider Business Practice Location Address
First Line	:	163 TROUTMAN ST
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11206-6307
Country	:	US
Telephone Number	:	201-663-3786
Fax Number	:

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

Provider Enumeration Date	:	12/02/2021
Last Update Date	:	01/18/2024

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