MEDICARE: EVE GAIL ABZUG 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	101YA0400X	Addiction (Substance Use Disorder) Counselor
2	1041C0700X	Clinical Social Worker	RO525911	NY

General Provider Information

NPI Number	:	1922266220
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EVE GAIL ABZUG LCSW

Provider Business Mailing Address
First Line	:	122 W 27TH ST
Second Line	:	6TH FLOOR
City	:	NEW YORK
State	:	NY
Zip	:	10001-6227
Country	:	US
Telephone Number	:	212-691-2900
Fax Number	:	212-675-2985

Provider Business Practice Location Address
First Line	:	122 W 27TH ST
Second Line	:	6TH FLOOR
City	:	NEW YORK
State	:	NY
Zip	:	10001-6227
Country	:	US
Telephone Number	:	212-691-2900
Fax Number	:	212-675-2985

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

Provider Enumeration Date	:	05/23/2008
Last Update Date	:	05/23/2008

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