MEDICARE: NANETTE FLEISCHER 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	104100000X	Social Worker	074764	NY

General Provider Information

NPI Number	:	1710176078
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NANETTE FLEISCHER LCSW

Provider Business Mailing Address
First Line	:	PO BOX 60725
Second Line	:
City	:	STATEN ISLAND
State	:	NY
Zip	:	10306-0725
Country	:	US
Telephone Number	:	718-815-3500
Fax Number	:	718-764-6064

Provider Business Practice Location Address
First Line	:	1082 VICTORY BLVD
Second Line	:
City	:	STATEN ISLAND
State	:	NY
Zip	:	10301-3622
Country	:	US
Telephone Number	:	718-815-3500
Fax Number	:	718-764-6064

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

Provider Enumeration Date	:	10/23/2007
Last Update Date	:	12/02/2013

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