MEDICARE: MS. JUDITH D ADELSON 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	PR018910	NY

General Provider Information

NPI Number	:	1679656128
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. JUDITH D ADELSON LCSW

Provider Business Mailing Address
First Line	:	425 RIVERSIDE DR
Second Line	:	#8C
City	:	NEW YORK CITY
State	:	NY
Zip	:	10025-7728
Country	:	US
Telephone Number	:	212-222-4486
Fax Number	:	212-663-6444

Provider Business Practice Location Address
First Line	:	425 RIVERSIDE DR
Second Line	:	#8C
City	:	NEW YORK CITY
State	:	NY
Zip	:	10025-7728
Country	:	US
Telephone Number	:	212-222-4486
Fax Number	:	212-663-6444

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

Provider Enumeration Date	:	10/20/2006
Last Update Date	:	08/06/2010

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