MEDICARE: MS. LEONORA LOVELL LCSW R

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	104100000X	Social Worker	R0532081	NY

General Provider Information

NPI Number	:	1689697849
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. LEONORA LOVELL LCSW R

Provider Business Mailing Address
First Line	:	PO BOX 757
Second Line	:
City	:	ELLENVILLE
State	:	NY
Zip	:	12428
Country	:	US
Telephone Number	:	845-647-5447
Fax Number	:

Provider Business Practice Location Address
First Line	:	276 HUDSON ST
Second Line	:
City	:	CORNWALL ON THE HUDSON
State	:	NY
Zip	:	12520
Country	:	US
Telephone Number	:	845-534-2926
Fax Number	:

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

Provider Enumeration Date	:	07/26/2006
Last Update Date	:	07/08/2007

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