MEDICARE: CRYSTAL M WELCH-SCOTT 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	087322-1	NY

General Provider Information

NPI Number	:	1952866519
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CRYSTAL M WELCH-SCOTT LCSW

Provider Business Mailing Address
First Line	:	10L GARDEN TER
Second Line	:
City	:	NORTH ARLINGTON
State	:	NJ
Zip	:	07031-8211
Country	:	US
Telephone Number	:	917-582-0670
Fax Number	:

Provider Business Practice Location Address
First Line	:	460 W 41ST ST
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10036-6801
Country	:	US
Telephone Number	:	212-613-0300
Fax Number	:

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

Provider Enumeration Date	:	02/07/2019
Last Update Date	:	02/07/2019

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