MEDICARE: MS. MICHELE LYNN INSALACO 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	085896-1	NY

General Provider Information

NPI Number	:	1679057616
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. MICHELE LYNN INSALACO LCSW

Provider Business Mailing Address
First Line	:	599 BEDFORD RD
Second Line	:
City	:	TARRYTOWN
State	:	NY
Zip	:	10591-1215
Country	:	US
Telephone Number	:	914-332-4250
Fax Number	:

Provider Business Practice Location Address
First Line	:	1606 OLD ORCHARD ST
Second Line	:
City	:	WEST HARRISON
State	:	NY
Zip	:	10604-1049
Country	:	US
Telephone Number	:	914-332-4250
Fax Number	:

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

Provider Enumeration Date	:	09/15/2018
Last Update Date	:	09/15/2018

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