MEDICARE: MS. EMILY RUTH SOREL MSW/LCSW-R

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	30230R	NY

General Provider Information

NPI Number	:	1417062001
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. EMILY RUTH SOREL MSW/LCSW-R

Provider Business Mailing Address
First Line	:	2498 SLATERVILLE RD
Second Line	:
City	:	SLATERVILLE SPRINGS
State	:	NY
Zip	:	14881-9403
Country	:	US
Telephone Number	:	607-227-0784
Fax Number	:	607-539-6724

Provider Business Practice Location Address
First Line	:	2498 SLATERVILLE RD
Second Line	:
City	:	SLATERVILLE SPRINGS
State	:	NY
Zip	:	14881-9403
Country	:	US
Telephone Number	:	607-227-0784
Fax Number	:	607-539-6724

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

Provider Enumeration Date	:	08/21/2006
Last Update Date	:	09/24/2020

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