MEDICARE: MRS. LAURIE M CORLIN 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	RO24085-1	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	RO24085-1	OTHER	NY	CLINICAL SOCIAL WORKER

General Provider Information

NPI Number	:	1730283300
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. LAURIE M CORLIN LCSW

Provider Business Mailing Address
First Line	:	1307 AVENUE L
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11230-4819
Country	:	US
Telephone Number	:	718-951-9025
Fax Number	:

Provider Business Practice Location Address
First Line	:	1358 56TH ST
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11219-4616
Country	:	US
Telephone Number	:	718-851-7100
Fax Number	:

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

Provider Enumeration Date	:	09/12/2006
Last Update Date	:	07/08/2007

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