Healthcare Provider Details

I. General information

NPI: 1396305017
Provider Name (Legal Business Name): PAUL DEL GIUDICE LICSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/14/2019
Last Update Date: 07/02/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

64 GILES ST
HEFLIN AL
36264-1738
US

IV. Provider business mailing address

PO BOX 97
GADSDEN AL
35902-0097
US

V. Phone/Fax

Practice location:
  • Phone: 256-463-2021
  • Fax:
Mailing address:
  • Phone: 256-492-0131
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number4266C
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: