MEDICARE: CHARLES KENNETH ELIN 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	027945	NY

General Provider Information

NPI Number	:	1922263763
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHARLES KENNETH ELIN LCSW

Provider Business Mailing Address
First Line	:	4 GILCHREST RD
Second Line	:
City	:	CONGERS
State	:	NY
Zip	:	10920-2332
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1 BRYANT CRES
Second Line	:
City	:	WHITE PLAINS
State	:	NY
Zip	:	10605-2637
Country	:	US
Telephone Number	:	845-642-7762
Fax Number	:

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

Provider Enumeration Date	:	07/21/2008
Last Update Date	:	07/21/2008

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