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NPI Code Detail

MEDICARE: FAYE SUE WILBUR MSW, LCSW

MEDICARE: FAYE SUE WILBUR MSW, 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
1104100000XSocial WorkerR027416-1NY

General Provider Information

NPI Number : 1548352776
Entity Type Code : Individual
Provider Name (Legal Business Name) : FAYE SUE WILBUR MSW, LCSW
Provider Business Mailing Address
First Line : 2014 NEW YORK AVE
Second Line :
City : BROOKLYN
State : NY
Zip : 11210-4824
Country : US
Telephone Number : 718-258-1046
Fax Number :
Provider Business Practice Location Address
First Line : 1273 53RD ST
Second Line : 4TH FLOOR
City : BROOKLYN
State : NY
Zip : 11219-3820
Country : US
Telephone Number : 718-435-5700
Fax Number : 718-854-5495
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/28/2006
Last Update Date : 07/08/2007

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