MEDICARE: NICHELLE LLEWELLYN 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	10904801	NY

General Provider Information

NPI Number	:	1760120943
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NICHELLE LLEWELLYN LMSW

Provider Business Mailing Address
First Line	:	1130 PELHAM PKWY S APT 2C
Second Line	:
City	:	BRONX
State	:	NY
Zip	:	10461-1021
Country	:	US
Telephone Number	:	646-709-5561
Fax Number	:

Provider Business Practice Location Address
First Line	:	100 PARK AVE FL 16
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10017-5538
Country	:	US
Telephone Number	:	212-433-2384
Fax Number	:

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

Provider Enumeration Date	:	05/26/2022
Last Update Date	:	05/26/2022

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