MEDICARE: MR. LEROY MINSON LCSW, ACSW

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	44SC04320800	NJ

General Provider Information

NPI Number	:	1518057066
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. LEROY MINSON LCSW, ACSW

Provider Business Mailing Address
First Line	:	2810 MORRIS AVE
Second Line	:	SUITE 209
City	:	UNION
State	:	NJ
Zip	:	07083-4850
Country	:	US
Telephone Number	:	908-349-8760
Fax Number	:	908-349-8092

Provider Business Practice Location Address
First Line	:	2810 MORRIS AVE
Second Line	:	SUITE 209
City	:	UNION
State	:	NJ
Zip	:	07083-4850
Country	:	US
Telephone Number	:	908-349-8760
Fax Number	:	908-349-8092

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

Provider Enumeration Date	:	10/13/2006
Last Update Date	:	11/21/2013

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