MEDICARE: MR. CLARENCE DUNCAN 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	074064-1	NY
2	101YA0400X	Addiction (Substance Use Disorder) Counselor	6035	NY

General Provider Information

NPI Number	:	1720226624
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. CLARENCE DUNCAN LCSW

Provider Business Mailing Address
First Line	:	2855 WHITE PLAINS RD
Second Line	:
City	:	BRONX
State	:	NY
Zip	:	10467-8114
Country	:	US
Telephone Number	:	718-881-8200
Fax Number	:	718-881-8211

Provider Business Practice Location Address
First Line	:	2855 WHITE PLAINS RD
Second Line	:
City	:	BRONX
State	:	NY
Zip	:	10467-8114
Country	:	US
Telephone Number	:	718-881-8200
Fax Number	:	718-881-8211

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

Provider Enumeration Date	:	01/30/2009
Last Update Date	:	02/04/2009

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