MEDICARE: MS. THERESA A. TAYLOR LCSW-R

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	R-035304-1	NY

General Provider Information

NPI Number	:	1578726345
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. THERESA A. TAYLOR LCSW-R

Provider Business Mailing Address
First Line	:	1273 NORTH AVE
Second Line	:	APT. 3C6
City	:	NEW ROCHELLE
State	:	NY
Zip	:	10804-2702
Country	:	US
Telephone Number	:	914-632-4549
Fax Number	:

Provider Business Practice Location Address
First Line	:	1273 NORTH AVE
Second Line	:	APT. 3C6
City	:	NEW ROCHELLE
State	:	NY
Zip	:	10804-2702
Country	:	US
Telephone Number	:	914-632-4549
Fax Number	:

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

Provider Enumeration Date	:	07/02/2008
Last Update Date	:	04/27/2013

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