MEDICARE: MS. JEAN LOUISE ANIEBONA 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	PR018925-1	NY

General Provider Information

NPI Number	:	1982827739
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. JEAN LOUISE ANIEBONA LCSW

Provider Business Mailing Address
First Line	:	210 E 15TH ST
Second Line	:	8L
City	:	NEW YORK
State	:	NY
Zip	:	10003-3922
Country	:	US
Telephone Number	:	212-475-8458
Fax Number	:	212-475-9218

Provider Business Practice Location Address
First Line	:	210 E 15TH ST
Second Line	:	8L
City	:	NEW YORK
State	:	NY
Zip	:	10003-3922
Country	:	US
Telephone Number	:	212-475-8458
Fax Number	:	212-475-9218

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

Provider Enumeration Date	:	04/10/2007
Last Update Date	:	07/08/2007

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