MEDICARE: DR. MYRA WEISS D.S.W.

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	R18783	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	R18783	OTHER	NY	SOCIAL WORK LICENSE

General Provider Information

NPI Number	:	1922203678
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MYRA WEISS D.S.W.

Provider Business Mailing Address
First Line	:	372 CENTRAL PARK W APT 14M
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10025-8209
Country	:	US
Telephone Number	:	212-316-7855
Fax Number	:	212-316-7855

Provider Business Practice Location Address
First Line	:	372 CENTRAL PARK W APT 3L
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10025-8203
Country	:	US
Telephone Number	:	212-316-7855
Fax Number	:	212-316-7855

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

Provider Enumeration Date	:	06/20/2007
Last Update Date	:	07/08/2007

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