MEDICARE: MRS. MELANIE ROSE PASTERNAK LMSW

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	104100000X	Social Worker	067121-1	NY

General Provider Information

NPI Number	:	1750409777
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. MELANIE ROSE PASTERNAK LMSW

Provider Business Mailing Address
First Line	:	1811 OCEAN PKWY
Second Line	:	APT. 4B
City	:	BROOKLYN
State	:	NY
Zip	:	11223-3059
Country	:	US
Telephone Number	:	718-608-5638
Fax Number	:

Provider Business Practice Location Address
First Line	:	111 LIVINGSTON ST
Second Line	:	SUITE, 1101
City	:	BROOKLYN
State	:	NY
Zip	:	11201-1260
Country	:	US
Telephone Number	:	718-625-4055
Fax Number	:

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

Provider Enumeration Date	:	03/27/2007
Last Update Date	:	05/02/2014

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