MEDICARE: MR. FRED FLORES LMSW

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	101Y00000X	Counselor	049720-1	NY
2	104100000X	Social Worker	049720-1	NY

General Provider Information

NPI Number	:	1558618447
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. FRED FLORES LMSW

Provider Business Mailing Address
First Line	:	1437 1ST AVE
Second Line	:	4FN
City	:	NEW YORK
State	:	NY
Zip	:	10021-3334
Country	:	US
Telephone Number	:	646-382-8028
Fax Number	:

Provider Business Practice Location Address
First Line	:	1437 1ST AVE
Second Line	:	4FN
City	:	NEW YORK
State	:	NY
Zip	:	10021-3334
Country	:	US
Telephone Number	:	646-382-8028
Fax Number	:

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

Provider Enumeration Date	:	08/09/2012
Last Update Date	:	08/09/2012

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Directions to “ MR. FRED FLORES LMSW” Practice Location

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