MEDICARE: LAURA C. SUMMERHILL 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	073191	NY

General Provider Information

NPI Number	:	1497911390
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LAURA C. SUMMERHILL LCSW

Provider Business Mailing Address
First Line	:	326 KEAP STREET #2
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11211
Country	:	US
Telephone Number	:	718-415-6406
Fax Number	:

Provider Business Practice Location Address
First Line	:	153 ROEBLING ST
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11211-3363
Country	:	US
Telephone Number	:	718-415-6406
Fax Number	:

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

Provider Enumeration Date	:	07/31/2008
Last Update Date	:	04/16/2009

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