MEDICARE: OMAYRA ROLON 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	R059509-1	NY

General Provider Information

NPI Number	:	1497930846
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	OMAYRA ROLON LCSW

Provider Business Mailing Address
First Line	:	1 GUSTAVE L. LEVY PLACE
Second Line	:	BOX 1030 - MOUNT SINAI HOSPITAL
City	:	NEW YORK
State	:	NY
Zip	:	10029-6501
Country	:	US
Telephone Number	:	212-241-4677
Fax Number	:	212-410-7196

Provider Business Practice Location Address
First Line	:	1 GUSTAVE L. LEVY PLACE
Second Line	:	MOUNT SINAI HOSPITAL
City	:	NEW YORK
State	:	NY
Zip	:	10029-6501
Country	:	US
Telephone Number	:	212-241-4677
Fax Number	:	212-410-7196

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

Provider Enumeration Date	:	01/04/2008
Last Update Date	:	01/04/2008

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