MEDICARE: MS. LYNN PAULETTE RADOV L.C.S.W.

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	R032222	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1558333559
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. LYNN PAULETTE RADOV L.C.S.W.

Provider Business Mailing Address
First Line	:	346 CONEY ISLAND AVE
Second Line	:	101
City	:	BROOKLYN
State	:	NY
Zip	:	11218-1804
Country	:	US
Telephone Number	:	718-965-0273
Fax Number	:	718-965-2381

Provider Business Practice Location Address
First Line	:	346 CONEY ISLAND AVE
Second Line	:	101
City	:	BROOKLYN
State	:	NY
Zip	:	11218-1804
Country	:	US
Telephone Number	:	718-965-0273
Fax Number	:	718-965-2381

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

Provider Enumeration Date	:	02/03/2006
Last Update Date	:	02/14/2013

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