MEDICARE: CERENE L PRINCE 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	083198-1	NY

General Provider Information

NPI Number	:	1700397494
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CERENE L PRINCE LCSW

Provider Business Mailing Address
First Line	:	18915 119TH AVE
Second Line	:
City	:	SAINT ALBANS
State	:	NY
Zip	:	11412-3322
Country	:	US
Telephone Number	:	917-922-4538
Fax Number	:

Provider Business Practice Location Address
First Line	:	18915 119TH AVE
Second Line	:
City	:	SAINT ALBANS
State	:	NY
Zip	:	11412-3322
Country	:	US
Telephone Number	:	917-922-4538
Fax Number	:

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

Provider Enumeration Date	:	10/20/2017
Last Update Date	:	10/20/2017

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Directions to “ CERENE L PRINCE LCSW” Practice Location

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