MEDICARE: MS. ELLEN MENDEL L.C.S.W.

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	R026706-1	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	P1901371	OTHER	NY	OXFORD
2	58327000	OTHER	NY	AETNA
3	032287	OTHER	NY	VALUE OPTIONS

General Provider Information

NPI Number	:	1568594323
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. ELLEN MENDEL L.C.S.W.

Provider Business Mailing Address
First Line	:	372 CENTRAL PARK W APT 12N
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10025-8209
Country	:	US
Telephone Number	:	212-662-4193
Fax Number	:	212-666-0047

Provider Business Practice Location Address
First Line	:	372 CENTRAL PARK W APT 12N
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10025-8209
Country	:	US
Telephone Number	:	212-662-4193
Fax Number	:	212-666-0047

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

Provider Enumeration Date	:	03/09/2007
Last Update Date	:	07/08/2007

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