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NPI Code Detail

MEDICARE: DR. TERRY S AUDATE LCSW-R

MEDICARE: DR. TERRY S AUDATE 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
11041C0700XClinical Social Worker082329NY

General Provider Information

NPI Number : 1992173751
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. TERRY S AUDATE LCSW-R
Provider Business Mailing Address
First Line : 23318 130TH AVE
Second Line :
City : ROSEDALE
State : NY
Zip : 11422-1102
Country : US
Telephone Number : 646-423-1286
Fax Number :
Provider Business Practice Location Address
First Line : 23318 130TH AVE
Second Line :
City : ROSEDALE
State : NY
Zip : 11422-1102
Country : US
Telephone Number : 646-423-1286
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/10/2015
Last Update Date : 06/14/2023

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