MEDICARE: MS. SHARON MARINER 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	R24932	NY

General Provider Information

NPI Number	:	1760629430
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. SHARON MARINER LCSW

Provider Business Mailing Address
First Line	:	219 W 22ND ST
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10011-2702
Country	:	US
Telephone Number	:	212-989-1452
Fax Number	:

Provider Business Practice Location Address
First Line	:	219 W 22ND ST
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10011-2702
Country	:	US
Telephone Number	:	212-989-1452
Fax Number	:

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

Provider Enumeration Date	:	01/16/2009
Last Update Date	:	01/16/2009

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