MEDICARE: MRS. MARDOCHEE LOUIS MSW

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

General Provider Information

NPI Number	:	1558017855
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. MARDOCHEE LOUIS MSW

Provider Business Mailing Address
First Line	:	164 SUYDAM ST
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11221-3309
Country	:	US
Telephone Number	:	934-852-0671
Fax Number	:

Provider Business Practice Location Address
First Line	:	164 SUYDAM ST
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11221-3309
Country	:	US
Telephone Number	:	934-852-0671
Fax Number	:

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

Provider Enumeration Date	:	02/24/2022
Last Update Date	:	02/24/2022

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