MEDICARE: MISS LIANA EFSTRATIADIS CSW

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	062091-1	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	062091-1	OTHER	NY	STATE LICENSE

General Provider Information

NPI Number	:	1881631141
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MISS LIANA EFSTRATIADIS CSW

Provider Business Mailing Address
First Line	:	1814 21ST DR
Second Line	:
City	:	ASTORIA
State	:	NY
Zip	:	11105-3936
Country	:	US
Telephone Number	:	718-207-0006
Fax Number	:

Provider Business Practice Location Address
First Line	:	501 5TH AVE
Second Line	:	SUITE 1709
City	:	NEW YORK
State	:	NY
Zip	:	10017-6129
Country	:	US
Telephone Number	:	718-207-0006
Fax Number	:

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

Provider Enumeration Date	:	06/02/2006
Last Update Date	:	08/11/2016

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