MEDICARE: MRS. LINDA LEFKON BOMSE 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	R039998	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	P2832533	OTHER	NY	OXFORD

General Provider Information

NPI Number	:	1477617785
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. LINDA LEFKON BOMSE LCSW

Provider Business Mailing Address
First Line	:	8 CHERRY LN
Second Line	:
City	:	SYOSSET
State	:	NY
Zip	:	11791-1808
Country	:	US
Telephone Number	:	516-921-7102
Fax Number	:	516-433-6307

Provider Business Practice Location Address
First Line	:	8 CHERRY LN
Second Line	:
City	:	SYOSSET
State	:	NY
Zip	:	11791-1808
Country	:	US
Telephone Number	:	516-921-7102
Fax Number	:	516-433-6307

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

Provider Enumeration Date	:	12/21/2006
Last Update Date	:	07/08/2007

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