MEDICARE: CHANELLE WARD

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	:	1558811976
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHANELLE WARD

Provider Business Mailing Address
First Line	:	14 BROADWAY TERRACE
Second Line	:	APT C
City	:	NEW YORK
State	:	NY
Zip	:	10040
Country	:	US
Telephone Number	:	646-209-7666
Fax Number	:

Provider Business Practice Location Address
First Line	:	425 E 25TH ST
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10010-2547
Country	:	US
Telephone Number	:	646-209-7666
Fax Number	:

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

Provider Enumeration Date	:	10/10/2016
Last Update Date	:	10/10/2016

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Directions to “ CHANELLE WARD ” Practice Location

Language	Start Address	Practice Location

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