MEDICARE: MRS. KATE KANE LCSW

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	PR009542	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	7402992	OTHER	NY	GHI

General Provider Information

NPI Number	:	1467489534
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. KATE KANE LCSW

Provider Business Mailing Address
First Line	:	203 PROSPECT RD
Second Line	:
City	:	CENTERPORT
State	:	NY
Zip	:	11721-1149
Country	:	US
Telephone Number	:	631-239-5522
Fax Number	:

Provider Business Practice Location Address
First Line	:	203 PROSPECT RD
Second Line	:
City	:	CENTERPORT
State	:	NY
Zip	:	11721-1149
Country	:	US
Telephone Number	:	631-239-5522
Fax Number	:

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

Provider Enumeration Date	:	06/26/2006
Last Update Date	:	07/08/2007

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