MEDICARE: GABRIEL BIRNBAUM 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	124663	NY

General Provider Information

NPI Number	:	1518793694
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GABRIEL BIRNBAUM LMSW

Provider Business Mailing Address
First Line	:	358 WESTMINSTER RD APT 3
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11218-4360
Country	:	US
Telephone Number	:	857-991-8543
Fax Number	:

Provider Business Practice Location Address
First Line	:	87 RICHARDSON ST
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11211-1306
Country	:	US
Telephone Number	:	857-991-8543
Fax Number	:

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

Provider Enumeration Date	:	09/13/2024
Last Update Date	:	09/13/2024

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