MEDICARE: MS. SUSAN M MCQUIRK LMSW, CASAC

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		NY

General Provider Information

NPI Number	:	1720258031
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. SUSAN M MCQUIRK LMSW, CASAC

Provider Business Mailing Address
First Line	:	5 TUDOR CITY PL
Second Line	:	APT337
City	:	NEW YORK
State	:	NY
Zip	:	10017-6853
Country	:	US
Telephone Number	:	212-867-6056
Fax Number	:

Provider Business Practice Location Address
First Line	:	5 TUDOR CITY PL
Second Line	:	APT337
City	:	NEW YORK
State	:	NY
Zip	:	10017-6853
Country	:	US
Telephone Number	:	212-867-6056
Fax Number	:

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

Provider Enumeration Date	:	03/04/2008
Last Update Date	:	03/04/2008

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