MEDICARE: MS. RITA M GOLUB 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	R0179741	NY

General Provider Information

NPI Number	:	1689832685
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. RITA M GOLUB LCSW

Provider Business Mailing Address
First Line	:	60 RIVERSIDE DRIVE
Second Line	:	#2E
City	:	NEW YORK CITY
State	:	NY
Zip	:	10029
Country	:	US
Telephone Number	:	212-580-0337
Fax Number	:

Provider Business Practice Location Address
First Line	:	60 RIVERSIDE DRIVE
Second Line	:	#2E
City	:	NEW YORK CITY
State	:	NY
Zip	:	10024
Country	:	US
Telephone Number	:	212-580-0337
Fax Number	:

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

Provider Enumeration Date	:	05/27/2008
Last Update Date	:	05/27/2008

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