MEDICARE: JOHN T DUNN 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	R045-661	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	R045-661	OTHER	NY	NYS LISCENSE

General Provider Information

NPI Number	:	1942488325
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOHN T DUNN LCSW

Provider Business Mailing Address
First Line	:	PO BOX 426
Second Line	:
City	:	SUGAR LOAF
State	:	NY
Zip	:	10981-0426
Country	:	US
Telephone Number	:	914-273-1260
Fax Number	:

Provider Business Practice Location Address
First Line	:	1407 KINGS HWY
Second Line	:
City	:	SUGAR LOAF
State	:	NY
Zip	:	10981-9800
Country	:	US
Telephone Number	:	914-273-1260
Fax Number	:

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

Provider Enumeration Date	:	02/07/2008
Last Update Date	:	02/07/2008

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