MEDICARE: MS. CINDY R DERN LCSW-R

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	R036475-1	NY

General Provider Information

NPI Number	:	1740362748
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. CINDY R DERN LCSW-R

Provider Business Mailing Address
First Line	:	14 WHITE TAIL DR.
Second Line	:
City	:	BEARSVILLE
State	:	NY
Zip	:	12409-0314
Country	:	US
Telephone Number	:	845-679-8184
Fax Number	:

Provider Business Practice Location Address
First Line	:	15 PINE GROVE ST
Second Line	:
City	:	WOODSTOCK
State	:	NY
Zip	:	12498-1507
Country	:	US
Telephone Number	:	845-679-5511
Fax Number	:

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

Provider Enumeration Date	:	10/19/2006
Last Update Date	:	07/08/2007

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