MEDICARE: MS. SUSAN COSMER LEONE 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	1041S0200X	School Social Worker	073021	NY

General Provider Information

NPI Number	:	1932480811
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. SUSAN COSMER LEONE LCSW

Provider Business Mailing Address
First Line	:	9 BRICE ST
Second Line	:
City	:	AMSTERDAM
State	:	NY
Zip	:	12010-5101
Country	:	US
Telephone Number	:	518-843-2871
Fax Number	:

Provider Business Practice Location Address
First Line	:	9 BRICE ST
Second Line	:
City	:	AMSTERDAM
State	:	NY
Zip	:	12010-5101
Country	:	US
Telephone Number	:	518-843-2871
Fax Number	:

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

Provider Enumeration Date	:	09/06/2011
Last Update Date	:	09/06/2011

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