MEDICARE: CITRUS COUNTY COUNSELING

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	SW12783	FL

General Provider Information

NPI Number	:	1265973382
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CITRUS COUNTY COUNSELING

Provider Business Mailing Address
First Line	:	4882 W PHOENIX DR
Second Line	:
City	:	BEVERLY HILLS
State	:	FL
Zip	:	34465-2860
Country	:	US
Telephone Number	:	352-423-3163
Fax Number	:

Provider Business Practice Location Address
First Line	:	4882 W PHOENIX DR
Second Line	:
City	:	BEVERLY HILLS
State	:	FL
Zip	:	34465-2860
Country	:	US
Telephone Number	:	352-423-3163
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	ROSE MARIE BASCOS
Credential	:	MSW, LCSW, MCAP
Telephone Number	:	352-623-3163

Provider Enumeration Date	:	03/09/2017
Last Update Date	:	03/09/2017

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