MEDICARE: MS. BARBARA SUE MAUTNER 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	R 028598-1	NY

General Provider Information

NPI Number	:	1972704401
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. BARBARA SUE MAUTNER LCSW

Provider Business Mailing Address
First Line	:	251 E 51ST ST
Second Line	:	12B
City	:	NEW YORK
State	:	NY
Zip	:	10022-6534
Country	:	US
Telephone Number	:	212-586-0606
Fax Number	:	212-755-7127

Provider Business Practice Location Address
First Line	:	80 WALL ST
Second Line	:	SUITE 511
City	:	NEW YORK
State	:	NY
Zip	:	10005-3601
Country	:	US
Telephone Number	:	212-586-0606
Fax Number	:	212-755-7127

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

Provider Enumeration Date	:	05/31/2007
Last Update Date	:	07/08/2007

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