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Elissa Glickman, LEFT 501 East Boston Post Rd. Mamaroneck, NY 10543 (914) 5172827 AUTHORIZATION FOR USE OR DISCLOSURE OF PROTECTED HEALTH INFORMATION (Page 1 of 2) 1. Clients name: First Name 2. Date
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501 east boston post is a form used to report certain information to the IRS, specifically related to tax-exempt organizations.
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