MEDICARE: ELIZABETH AGUILUZ SOCIAL WORKER, 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

General Provider Information

NPI Number	:	1417150996
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ELIZABETH AGUILUZ SOCIAL WORKER, MSW

Provider Business Mailing Address
First Line	:	260 SEAMAN AVE APT F5
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10034-1289
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	UPPER MANHATTAN MENTAL HEALTH CENTER
Second Line	:	1727 AMSTERDAM AVENUE
City	:	NEW YORK
State	:	NY
Zip	:	10031
Country	:	US
Telephone Number	:	212-694-9200
Fax Number	:

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

Provider Enumeration Date	:	06/11/2007
Last Update Date	:	07/08/2007

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