MEDICARE: REBECCA HELLER LCSW

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	086594	NY

General Provider Information

NPI Number	:	1588223077
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	REBECCA HELLER LCSW

Provider Business Mailing Address
First Line	:	3222 37TH ST
Second Line	:
City	:	ASTORIA
State	:	NY
Zip	:	11103-4004
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	290 LENOX AVE
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10027-4991
Country	:	US
Telephone Number	:	212-663-3000
Fax Number	:

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

Provider Enumeration Date	:	06/10/2019
Last Update Date	:	06/10/2019

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