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NPI Code Detail

MEDICARE: ANTONIO GAETA JR.

MEDICARE: ANTONIO GAETA JR.
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
11041C0700XClinical Social Worker34012305AIN

General Provider Information

NPI Number : 1962185223
Entity Type Code : Individual
Provider Name (Legal Business Name) : ANTONIO GAETA JR.
Provider Business Mailing Address
First Line : 90 EXECUTIVE DR STE B
Second Line :
City : CARMEL
State : IN
Zip : 46032-2612
Country : US
Telephone Number : 317-674-3121
Fax Number :
Provider Business Practice Location Address
First Line : 90 EXECUTIVE DR STE B
Second Line :
City : CARMEL
State : IN
Zip : 46032-2612
Country : US
Telephone Number : 317-674-3121
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/11/2023
Last Update Date : 06/08/2026

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