MEDICARE: ELIZABETH M PADILLA 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	72072283	NY

General Provider Information

NPI Number	:	1801278585
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ELIZABETH M PADILLA LMSW

Provider Business Mailing Address
First Line	:	512 SOUTHERN BLVD
Second Line	:
City	:	BRONX
State	:	NY
Zip	:	10455-4600
Country	:	US
Telephone Number	:	718-993-1078
Fax Number	:	718-993-1260

Provider Business Practice Location Address
First Line	:	512 SOUTHERN BLVD
Second Line	:
City	:	BRONX
State	:	NY
Zip	:	10455-4600
Country	:	US
Telephone Number	:	718-993-1078
Fax Number	:	718-993-1260

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

Provider Enumeration Date	:	06/18/2015
Last Update Date	:	06/18/2015

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