MEDICARE: SIDNEY PECH L.C.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	RO28799-1	NY

General Provider Information

NPI Number	:	1932189313
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SIDNEY PECH L.C.S.W.

Provider Business Mailing Address
First Line	:	2626 E 14TH ST STE 101E
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11235-3976
Country	:	US
Telephone Number	:	718-715-6666
Fax Number	:

Provider Business Practice Location Address
First Line	:	2626 E 14TH ST STE 101E
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11235-3976
Country	:	US
Telephone Number	:	718-715-6666
Fax Number	:

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

Provider Enumeration Date	:	01/20/2006
Last Update Date	:	04/02/2019

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