MEDICARE: MICHELE BETH TAUBENBLAT MS

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	101Y00000X	Counselor

General Provider Information

NPI Number	:	1669190096
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHELE BETH TAUBENBLAT MS

Provider Business Mailing Address
First Line	:	729 W 186TH ST APT 5G
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10033-8508
Country	:	US
Telephone Number	:	917-940-4623
Fax Number	:

Provider Business Practice Location Address
First Line	:	729 W 186TH ST APT 5G
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10033-8508
Country	:	US
Telephone Number	:	917-940-4623
Fax Number	:

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

Provider Enumeration Date	:	08/22/2022
Last Update Date	:	08/22/2022

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