MEDICARE: REBECCA L WULF 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	073893-1	NY

General Provider Information

NPI Number	:	1841214418
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	REBECCA L WULF LCSW

Provider Business Mailing Address
First Line	:	7618 69TH PL APT 3D
Second Line	:
City	:	GLENDALE
State	:	NY
Zip	:	11385-7136
Country	:	US
Telephone Number	:	347-813-5932
Fax Number	:

Provider Business Practice Location Address
First Line	:	3312 SURF AVE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11224-1406
Country	:	US
Telephone Number	:	718-372-3300
Fax Number	:

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

Provider Enumeration Date	:	07/27/2006
Last Update Date	:	07/08/2007

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