MEDICARE: MILESTONE PSYCHOTHERAPY, LCSW, PC

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	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)	R049291-1	NY

General Provider Information

NPI Number	:	1871974261
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MILESTONE PSYCHOTHERAPY, LCSW, PC

Provider Business Mailing Address
First Line	:	2010 WILLIAMSBRIDGE RD
Second Line	:	2ND FLOOR
City	:	BRONX
State	:	NY
Zip	:	10461-1603
Country	:	US
Telephone Number	:	718-409-6000
Fax Number	:	718-239-0039

Provider Business Practice Location Address
First Line	:	2010 WILLIAMSBRIDGE RD
Second Line	:	2ND FLOOR
City	:	BRONX
State	:	NY
Zip	:	10461-1603
Country	:	US
Telephone Number	:	718-409-6000
Fax Number	:	718-239-0039

Authorized Official
Title or Position	:	CLINICAL SOCIAL WORKER/PRESIDENT
Name	:	MS. HILDA R HERNANDEZ
Credential	:	LCSW
Telephone Number	:	516-652-7014

Provider Enumeration Date	:	06/11/2015
Last Update Date	:	06/11/2015

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