MEDICARE: MRS. MARY DIPAOLA-SHAH 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	104100000X	Social Worker	068880	NY

General Provider Information

NPI Number	:	1477708121
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. MARY DIPAOLA-SHAH LMSW

Provider Business Mailing Address
First Line	:	15 LOUISA CT
Second Line	:
City	:	NORTHPORT
State	:	NY
Zip	:	11768-3062
Country	:	US
Telephone Number	:	631-988-1302
Fax Number	:

Provider Business Practice Location Address
First Line	:	125 E BETHPAGE RD
Second Line	:
City	:	PLAINVIEW
State	:	NY
Zip	:	11803-4228
Country	:	US
Telephone Number	:	516-731-5588
Fax Number	:

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

Provider Enumeration Date	:	11/21/2008
Last Update Date	:	11/21/2008

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