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NPI Code Detail

MEDICARE: MS. RANDI WAXMAN LCSW-R

MEDICARE: MS. RANDI WAXMAN LCSW-R
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
11041C0700XClinical Social Worker071590NY

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1071590OTHERNYLCSW

General Provider Information

NPI Number : 1912061268
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. RANDI WAXMAN LCSW-R
Provider Business Mailing Address
First Line : 124 NORTH MERRICK AVENUE
Second Line : SUITE #7
City : MERRICK
State : NY
Zip : 11566-3434
Country : US
Telephone Number : 516-868-8867
Fax Number :
Provider Business Practice Location Address
First Line : 124 MERRICK AVE
Second Line : SUITE #7
City : MERRICK
State : NY
Zip : 11566-3434
Country : US
Telephone Number : 516-868-8867
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/21/2006
Last Update Date : 04/02/2009

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