MEDICARE: LINLIN FAN 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	095314	NY
2	1041C0700X	Clinical Social Worker	087527	NY

General Provider Information

NPI Number	:	1790160513
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LINLIN FAN LMSW

Provider Business Mailing Address
First Line	:	14 WALL ST FL 9
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10005-2178
Country	:	US
Telephone Number	:	646-501-3309
Fax Number	:

Provider Business Practice Location Address
First Line	:	330 59TH ST
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11220-3718
Country	:	US
Telephone Number	:	718-439-5962
Fax Number	:	718-439-0948

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

Provider Enumeration Date	:	07/22/2015
Last Update Date	:	11/05/2018

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Directions to “ LINLIN FAN LMSW” Practice Location

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