MEDICARE: MR. GORDON A PILET 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	SW 5799	FL

General Provider Information

NPI Number	:	1194058651
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. GORDON A PILET LCSW

Provider Business Mailing Address
First Line	:	718 W MARTIN LUTHER KING JR BLVD
Second Line	:	SUITE 200
City	:	TAMPA
State	:	FL
Zip	:	33603-3135
Country	:	US
Telephone Number	:	813-933-8865
Fax Number	:	813-933-7285

Provider Business Practice Location Address
First Line	:	718 W MARTIN LUTHER KING JR BLVD
Second Line	:	SUITE 200
City	:	TAMPA
State	:	FL
Zip	:	33603-3135
Country	:	US
Telephone Number	:	813-933-8865
Fax Number	:	813-933-7285

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

Provider Enumeration Date	:	09/15/2009
Last Update Date	:	09/15/2009

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