MEDICARE: FAUZIA CHOUDHURY LMSW/LSW

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	44SL07067300	NJ
2	1041C0700X	Clinical Social Worker	122887-01	NY

General Provider Information

NPI Number	:	1649027848
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	FAUZIA CHOUDHURY LMSW/LSW

Provider Business Mailing Address
First Line	:	220 5TH AVE
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10001-7708
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	10431 212TH ST
Second Line	:
City	:	QUEENS VILLAGE
State	:	NY
Zip	:	11429-1546
Country	:	US
Telephone Number	:	917-547-2325
Fax Number	:

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

Provider Enumeration Date	:	05/04/2024
Last Update Date	:	05/04/2024

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