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NPI Code Detail

MEDICARE: MS. JACQUELINE S OERTEL LCSW

MEDICARE: MS. JACQUELINE S OERTEL 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
11041C0700XClinical Social WorkerR042722-1NY

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
14034838OTHERNYTRICARE

General Provider Information

NPI Number : 1528076254
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. JACQUELINE S OERTEL LCSW
Provider Business Mailing Address
First Line : 174 US OVAL
Second Line :
City : PLATTSBURGH
State : NY
Zip : 12903-3900
Country : US
Telephone Number : 518-324-5727
Fax Number :
Provider Business Practice Location Address
First Line : 174 US OVAL
Second Line :
City : PLATTSBURGH
State : NY
Zip : 12903-3900
Country : US
Telephone Number : 518-324-5727
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/05/2006
Last Update Date : 07/08/2007

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