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NPI Code Detail

MEDICARE: MISS LISA REBECCA FOGEL M.S.W.

MEDICARE: MISS LISA REBECCA FOGEL M.S.W.
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
11041C0700XClinical Social Worker

General Provider Information

NPI Number : 1699970483
Entity Type Code : Individual
Provider Name (Legal Business Name) : MISS LISA REBECCA FOGEL M.S.W.
Provider Business Mailing Address
First Line : 978 E END
Second Line :
City : WOODMERE
State : NY
Zip : 11598-1006
Country : US
Telephone Number : 516-295-3050
Fax Number : 516-295-7858
Provider Business Practice Location Address
First Line : 7150 PARSONS BLVD
Second Line :
City : FLUSHING
State : NY
Zip : 11365-4131
Country : US
Telephone Number : 718-591-6750
Fax Number : 718-591-4397
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/20/2007
Last Update Date : 07/08/2007

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