MEDICARE: MS. DEBRA WADE L.C.S.W.

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	R0325301	NY

General Provider Information

NPI Number	:	1730256553
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. DEBRA WADE L.C.S.W.

Provider Business Mailing Address
First Line	:	329 BROWER AVE
Second Line	:
City	:	ROCKVILLE CENTRE
State	:	NY
Zip	:	11570
Country	:	US
Telephone Number	:	516-594-6955
Fax Number	:	516-594-6955

Provider Business Practice Location Address
First Line	:	1722 W 5TH ST
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11223-1471
Country	:	US
Telephone Number	:	347-713-3316
Fax Number	:	516-594-6955

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

Provider Enumeration Date	:	11/29/2006
Last Update Date	:	04/30/2010

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