MEDICARE: ADVANCED TREATMENT OPTIONS, LLC

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	Q1-0000571	DE
2	133V00000X	Registered Dietitian	DN-0000351	DE
3	364SP0808X	Psychiatric/Mental Health Clinical Nurse Specialist	LE-0000158	DE

General Provider Information

NPI Number	:	1275711236
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ADVANCED TREATMENT OPTIONS, LLC

Provider Business Mailing Address
First Line	:	604 MILLTOWN RD
Second Line	:
City	:	WILMINGTON
State	:	DE
Zip	:	19808-2227
Country	:	US
Telephone Number	:	888-517-2088
Fax Number	:	302-998-3242

Provider Business Practice Location Address
First Line	:	604 MILLTOWN RD
Second Line	:
City	:	WILMINGTON
State	:	DE
Zip	:	19808-2227
Country	:	US
Telephone Number	:	888-517-2088
Fax Number	:	302-998-3242

Authorized Official
Title or Position	:	MEMBER
Name	:	KAREN L. GIBBLE
Credential	:	APRN, BC
Telephone Number	:	888-517-2088

Provider Enumeration Date	:	02/01/2008
Last Update Date	:	03/03/2014

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