MEDICARE: MS. FERN SLOVIN RUDORFER LICSW

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	101YM0800X	Mental Health Counselor	R021626-1	NY

General Provider Information

NPI Number	:	1609983832
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. FERN SLOVIN RUDORFER LICSW

Provider Business Mailing Address
First Line	:	3924 AVENUE T
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11234-5028
Country	:	US
Telephone Number	:	718-252-0958
Fax Number	:

Provider Business Practice Location Address
First Line	:	3924 AVENUE T
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11234-5028
Country	:	US
Telephone Number	:	718-252-0958
Fax Number	:

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

Provider Enumeration Date	:	08/24/2006
Last Update Date	:	08/14/2009

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