MEDICARE: LYDIA MUNOZ 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	104100000X	Social Worker	44SC00446700	NJ
2	1041C0700X	Clinical Social Worker	44SC00446700	NJ
3	1041S0200X	School Social Worker	44SC00446700	NJ

General Provider Information

NPI Number	:	1780078824
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LYDIA MUNOZ LCSW

Provider Business Mailing Address
First Line	:	303 SUMNER ST
Second Line	:	PO BOX 61
City	:	LANDISVILLE
State	:	NJ
Zip	:	08326-1521
Country	:	US
Telephone Number	:	856-697-2967
Fax Number	:	856-697-0061

Provider Business Practice Location Address
First Line	:	3900 VENTNOR AVE
Second Line	:
City	:	ATLANTIC CITY
State	:	NJ
Zip	:	08401-5922
Country	:	US
Telephone Number	:	609-345-1249
Fax Number	:	609-345-8533

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

Provider Enumeration Date	:	03/26/2015
Last Update Date	:	03/26/2015

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