MEDICARE: BEHNAZ GITIPOUR 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	0904015002	VA

General Provider Information

NPI Number	:	1568165025
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BEHNAZ GITIPOUR LCSW

Provider Business Mailing Address
First Line	:	7915 DUKES DYNASTY DR
Second Line	:
City	:	RALEIGH
State	:	NC
Zip	:	27615-8049
Country	:	US
Telephone Number	:	513-919-8584
Fax Number	:

Provider Business Practice Location Address
First Line	:	7915 DUKES DYNASTY DR
Second Line	:
City	:	RALEIGH
State	:	NC
Zip	:	27615-8049
Country	:	US
Telephone Number	:	513-919-8584
Fax Number	:

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

Provider Enumeration Date	:	03/23/2023
Last Update Date	:	03/23/2023

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