MEDICARE: DR. MARY BETH MCLAUGHLIN CRESCI PH.D.

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	103TC0700X	Clinical Psychologist	004660-1	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0093630	OTHER	NY	GHI
2	147299	OTHER	NY	VALUE OPTIONS

General Provider Information

NPI Number	:	1992796098
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MARY BETH MCLAUGHLIN CRESCI PH.D.

Provider Business Mailing Address
First Line	:	10 PINEAPPLE ST
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11201-1615
Country	:	US
Telephone Number	:	718-625-0221
Fax Number	:

Provider Business Practice Location Address
First Line	:	10 PINEAPPLE ST
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11201-1615
Country	:	US
Telephone Number	:	718-625-0221
Fax Number	:

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

Provider Enumeration Date	:	10/30/2005
Last Update Date	:	07/08/2007

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