MEDICARE: CHRISTINE COSMOS LMSW

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	123081-01	NY

General Provider Information

NPI Number	:	1467204628
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHRISTINE COSMOS LMSW

Provider Business Mailing Address
First Line	:	2114 45TH ST
Second Line	:
City	:	ASTORIA
State	:	NY
Zip	:	11105-1302
Country	:	US
Telephone Number	:	917-873-1651
Fax Number	:

Provider Business Practice Location Address
First Line	:	250 E 164TH ST FL 1
Second Line	:
City	:	BRONX
State	:	NY
Zip	:	10456-6327
Country	:	US
Telephone Number	:	917-873-1651
Fax Number	:

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

Provider Enumeration Date	:	04/02/2024
Last Update Date	:	04/02/2024

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