MEDICARE: JESSICA BILES 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	1041C0700X	Clinical Social Worker

General Provider Information

NPI Number	:	1700132206
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JESSICA BILES LCSW-R

Provider Business Mailing Address
First Line	:	1028 LAKE VIEW RD
Second Line	:
City	:	COPAKE
State	:	NY
Zip	:	12516-1104
Country	:	US
Telephone Number	:	516-551-1343
Fax Number	:

Provider Business Practice Location Address
First Line	:	535 5TH AVE FL 4
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10017-8020
Country	:	US
Telephone Number	:	516-551-1343
Fax Number	:

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

Provider Enumeration Date	:	08/02/2012
Last Update Date	:	04/05/2021

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Directions to “ JESSICA BILES LCSW-R” Practice Location

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