MEDICARE: MARIA LOUISE HODERMARSKA LCAT

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	221700000X	Art Therapist	177	NY

General Provider Information

NPI Number	:	1588788319
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARIA LOUISE HODERMARSKA LCAT

Provider Business Mailing Address
First Line	:	149 NELSON ST
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11231-4003
Country	:	US
Telephone Number	:	718-522-6270
Fax Number	:

Provider Business Practice Location Address
First Line	:	149 NELSON ST
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11231-4003
Country	:	US
Telephone Number	:	718-522-6270
Fax Number	:

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

Provider Enumeration Date	:	03/19/2007
Last Update Date	:	07/08/2007

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