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NPI Code Detail

MEDICARE: SOCIAL THERAPY CONTRACTOR LCSW LLC

MEDICARE: SOCIAL THERAPY CONTRACTOR LCSW LLC
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 WorkerR046837-1NY

General Provider Information

NPI Number : 1457885329
Entity Type Code : Organization
Provider Name (Legal Business Name) : SOCIAL THERAPY CONTRACTOR LCSW LLC
Provider Business Mailing Address
First Line : 17 DEVON PL
Second Line :
City : STATEN ISLAND
State : NY
Zip : 10301-2012
Country : US
Telephone Number : 718-720-0174
Fax Number :
Provider Business Practice Location Address
First Line : 17 DEVON PL
Second Line :
City : STATEN ISLAND
State : NY
Zip : 10301-2012
Country : US
Telephone Number : 718-720-0174
Fax Number :
Authorized Official
Title or Position : CEO
Name : MRS. TERRY J BLOCKER
Credential : MSW
Telephone Number : 718-720-0174
Provider Enumeration Date : 04/17/2017
Last Update Date : 04/17/2017

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