MEDICARE: MS. REGINE PODRIZKI MSW

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	R0131701LCSW	NY

General Provider Information

NPI Number	:	1407916869
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. REGINE PODRIZKI MSW

Provider Business Mailing Address
First Line	:	706 EASTERN PARKWAY
Second Line	:	#6G
City	:	BROOKLYN
State	:	NY
Zip	:	11213-3408
Country	:	US
Telephone Number	:	718-467-2094
Fax Number	:	718-363-6855

Provider Business Practice Location Address
First Line	:	706 EASTERN PARKWAY
Second Line	:	APT 6G
City	:	BROOKLYN
State	:	NY
Zip	:	11213-3408
Country	:	US
Telephone Number	:	718-467-2094
Fax Number	:	718-363-6855

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

Provider Enumeration Date	:	12/08/2006
Last Update Date	:	07/08/2007

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