MEDICARE: MR. EDGARDO QUINONES 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	053616	NY

General Provider Information

NPI Number	:	1629144019
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. EDGARDO QUINONES LCSW-R

Provider Business Mailing Address
First Line	:	260 E 188TH ST
Second Line	:	5TH FLOOR
City	:	BRONX
State	:	NY
Zip	:	10458-5302
Country	:	US
Telephone Number	:	718-960-0261
Fax Number	:	718-933-2502

Provider Business Practice Location Address
First Line	:	260 E 188TH ST
Second Line	:	5TH FLOOR
City	:	BRONX
State	:	NY
Zip	:	10458-5302
Country	:	US
Telephone Number	:	718-960-0261
Fax Number	:	718-933-2502

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

Provider Enumeration Date	:	11/28/2006
Last Update Date	:	07/08/2007

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