MEDICARE: MS. MAURA T. KILDUFF TURNER LCSW-R

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	R055846	NY

General Provider Information

NPI Number	:	1982691283
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. MAURA T. KILDUFF TURNER LCSW-R

Provider Business Mailing Address
First Line	:	457 LINDELL BLVD
Second Line	:
City	:	LONG BEACH
State	:	NY
Zip	:	11561-1744
Country	:	US
Telephone Number	:	516-897-7291
Fax Number	:	561-897-4561

Provider Business Practice Location Address
First Line	:	100 W PARK AVE
Second Line	:	SUITE 303A
City	:	LONG BEACH
State	:	NY
Zip	:	11561-3302
Country	:	US
Telephone Number	:	516-897-4561
Fax Number	:	516-897-4561

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

Provider Enumeration Date	:	10/02/2005
Last Update Date	:	07/08/2007

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