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NPI Code Detail

MEDICARE: MS. EILEEN GISSELLE TITO LMSW

MEDICARE: MS. EILEEN GISSELLE TITO LMSW
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
1104100000XSocial Worker131331NY

General Provider Information

NPI Number : 1578409454
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. EILEEN GISSELLE TITO LMSW
Provider Business Mailing Address
First Line : 5820 GRANGER ST APT 2
Second Line :
City : CORONA
State : NY
Zip : 11368-5610
Country : US
Telephone Number : 347-437-9005
Fax Number :
Provider Business Practice Location Address
First Line : 3708 91ST ST STE 3A
Second Line :
City : JACKSON HEIGHTS
State : NY
Zip : 11372-7962
Country : US
Telephone Number : 718-779-2263
Fax Number : 718-779-2225
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/24/2026
Last Update Date : 04/24/2026

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