MEDICARE: MRS. JAMIE M SACCA LCAT MT-BC

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	225A00000X	Music Therapist	09582	NY

General Provider Information

NPI Number	:	1588054753
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. JAMIE M SACCA LCAT MT-BC

Provider Business Mailing Address
First Line	:	2361 CRESCENT ST
Second Line	:	2ND FL
City	:	LONG ISLAND CITY
State	:	NY
Zip	:	11105-3107
Country	:	US
Telephone Number	:	631-525-6930
Fax Number	:

Provider Business Practice Location Address
First Line	:	2361 CRESCENT ST
Second Line	:	2ND FL
City	:	LONG ISLAND CITY
State	:	NY
Zip	:	11105-3107
Country	:	US
Telephone Number	:	631-525-6930
Fax Number	:

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

Provider Enumeration Date	:	01/27/2015
Last Update Date	:	01/27/2015

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