MEDICARE: ERIC MASCARA 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	091121	NY

General Provider Information

NPI Number	:	1821760273
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ERIC MASCARA LCSW

Provider Business Mailing Address
First Line	:	6116 N WINTHROP AVE APT 3E
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60660-5635
Country	:	US
Telephone Number	:	917-332-7962
Fax Number	:

Provider Business Practice Location Address
First Line	:	2248 BROADWAY # 1172
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10024-5805
Country	:	US
Telephone Number	:	917-332-7962
Fax Number	:

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

Provider Enumeration Date	:	10/04/2021
Last Update Date	:	10/04/2021

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Directions to “ ERIC MASCARA LCSW” Practice Location

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