MEDICARE: MS. LORRAINE J VESTRIS LACSW CPP

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	R0338601	NY

General Provider Information

NPI Number	:	1568522613
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. LORRAINE J VESTRIS LACSW CPP

Provider Business Mailing Address
First Line	:	223 E 78TH ST
Second Line	:	SUITE 1D
City	:	NEW YORK
State	:	NY
Zip	:	10075-1222
Country	:	US
Telephone Number	:	212-288-8159
Fax Number	:	212-452-1525

Provider Business Practice Location Address
First Line	:	223 E 78TH ST
Second Line	:	SUITE 1D
City	:	NEW YORK
State	:	NY
Zip	:	10075-1222
Country	:	US
Telephone Number	:	212-288-8159
Fax Number	:	212-452-1525

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

Provider Enumeration Date	:	12/11/2006
Last Update Date	:	09/14/2010

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