MEDICARE: LUCILLE GIACONE-KLEIN LCSW CORP

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	5991	FL

General Provider Information

NPI Number	:	1306397765
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LUCILLE GIACONE-KLEIN LCSW CORP

Provider Business Mailing Address
First Line	:	15175 93RD ST N
Second Line	:
City	:	WEST PALM BEACH
State	:	FL
Zip	:	33412-1798
Country	:	US
Telephone Number	:	561-389-2283
Fax Number	:

Provider Business Practice Location Address
First Line	:	1645 PALM BEACH LAKES BLVD STE 440
Second Line	:
City	:	WEST PALM BEACH
State	:	FL
Zip	:	33401-2217
Country	:	US
Telephone Number	:	561-389-2283
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	LUCILLE GIACONE-KLEIN LCSW CORP
Credential	:
Telephone Number	:	561-389-2283

Provider Enumeration Date	:	10/20/2016
Last Update Date	:	07/21/2022

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