MEDICARE: MS. MARGARETHA JOHANNA MARKESTEIJN PH.D.

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	074704	NY

General Provider Information

NPI Number	:	1891052312
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. MARGARETHA JOHANNA MARKESTEIJN PH.D.

Provider Business Mailing Address
First Line	:	595 BLOSSOM RD
Second Line	:	STE 314
City	:	ROCHESTER
State	:	NY
Zip	:	14610-1825
Country	:	US
Telephone Number	:	585-244-4335
Fax Number	:

Provider Business Practice Location Address
First Line	:	595 BLOSSOM RD
Second Line	:	STE 314
City	:	ROCHESTER
State	:	NY
Zip	:	14610-1825
Country	:	US
Telephone Number	:	585-244-4335
Fax Number	:

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

Provider Enumeration Date	:	04/20/2012
Last Update Date	:	04/20/2012

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