MEDICARE: MR. WILLIAM GROTH CSW

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	052993-1	NY

General Provider Information

NPI Number	:	1558572537
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. WILLIAM GROTH CSW

Provider Business Mailing Address
First Line	:	117 W 13TH ST APT 1
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10011-7832
Country	:	US
Telephone Number	:	212-696-8648
Fax Number	:

Provider Business Practice Location Address
First Line	:	117 W 13TH ST
Second Line	:	SUITE #1
City	:	NEW YORK
State	:	NY
Zip	:	10011-7832
Country	:	US
Telephone Number	:	212-696-8648
Fax Number	:

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

Provider Enumeration Date	:	05/24/2007
Last Update Date	:	07/08/2007

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