MEDICARE: MS. RIESA P MINAKAN 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	104100000X	Social Worker	083778	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	:	1558683912
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. RIESA P MINAKAN LMSW

Provider Business Mailing Address
First Line	:	6 GRAMATAN AVE
Second Line	:	C/O WJCS
City	:	MOUNT VERNON
State	:	NY
Zip	:	10550-3208
Country	:	US
Telephone Number	:	914-668-8938
Fax Number	:	914-668-2545

Provider Business Practice Location Address
First Line	:	6 GRAMATAN AVE
Second Line	:	C/O WJCS
City	:	MOUNT VERNON
State	:	NY
Zip	:	10550-3208
Country	:	US
Telephone Number	:	914-668-8938
Fax Number	:	914-668-2545

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

Provider Enumeration Date	:	02/25/2010
Last Update Date	:	06/20/2011

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