MEDICARE: LAURA MARESCA APPLEGATE 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	081830	NY

General Provider Information

NPI Number	:	1891089116
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LAURA MARESCA APPLEGATE LCSW

Provider Business Mailing Address
First Line	:	36 PLAZA ST E
Second Line	:	SUITE 1A
City	:	BROOKLYN
State	:	NY
Zip	:	11238-5048
Country	:	US
Telephone Number	:	929-244-3060
Fax Number	:

Provider Business Practice Location Address
First Line	:	36 PLAZA ST E
Second Line	:	SUITE 1A
City	:	BROOKLYN
State	:	NY
Zip	:	11238-5048
Country	:	US
Telephone Number	:	929-244-3060
Fax Number	:

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

Provider Enumeration Date	:	06/03/2011
Last Update Date	:	03/03/2015

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