MEDICARE: JAN MARIE ANDERSON MSW

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	101YM0800X	Mental Health Counselor

General Provider Information

NPI Number	:	1750343612
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JAN MARIE ANDERSON MSW

Provider Business Mailing Address
First Line	:	18 AMPERSAND DR
Second Line	:
City	:	PLATTSBURGH
State	:	NY
Zip	:	12901-6500
Country	:	US
Telephone Number	:	518-566-0100
Fax Number	:	518-561-1648

Provider Business Practice Location Address
First Line	:	18 AMPERSAND DR
Second Line	:
City	:	PLATTSBURGH
State	:	NY
Zip	:	12901-6500
Country	:	US
Telephone Number	:	518-566-0100
Fax Number	:	518-561-1648

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

Provider Enumeration Date	:	04/05/2006
Last Update Date	:	07/08/2007

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