MEDICARE: MRS. DIONNE MARIE TAYLOR-WYCOFF LMSW

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	104100000X	Social Worker	049862-1	NY

General Provider Information

NPI Number	:	1972751253
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. DIONNE MARIE TAYLOR-WYCOFF LMSW

Provider Business Mailing Address
First Line	:	448 HANCOCK ST
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11233-5612
Country	:	US
Telephone Number	:	917-209-2177
Fax Number	:	718-452-2652

Provider Business Practice Location Address
First Line	:	448 HANCOCK ST
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11233-5612
Country	:	US
Telephone Number	:	917-209-2177
Fax Number	:	718-452-2652

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

Provider Enumeration Date	:	08/28/2008
Last Update Date	:	08/28/2008

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