MEDICARE: MRS. PATRICIA SMUCKER 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	73074692	NY

General Provider Information

NPI Number	:	1659421030
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. PATRICIA SMUCKER LCSW

Provider Business Mailing Address
First Line	:	241 LAGOON DR W
Second Line	:
City	:	LIDO BEACH
State	:	NY
Zip	:	11561-4917
Country	:	US
Telephone Number	:	516-432-9542
Fax Number	:	516-432-9542

Provider Business Practice Location Address
First Line	:	241 LAGOON DR W
Second Line	:
City	:	LIDO BEACH
State	:	NY
Zip	:	11561-4917
Country	:	US
Telephone Number	:	516-432-9542
Fax Number	:	516-432-9542

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

Provider Enumeration Date	:	01/10/2007
Last Update Date	:	07/08/2007

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