Healthcare Provider Details

I. General information

NPI: 1356589923
Provider Name (Legal Business Name): JUNE TOMASO-WOOD LCSW LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/04/2009
Last Update Date: 02/04/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

269 VENICE PALMS BLVD
VENICE FL
34292-2449
US

IV. Provider business mailing address

269 VENICE PALMS BLVD
VENICE FL
34292-2449
US

V. Phone/Fax

Practice location:
  • Phone: 941-284-4268
  • Fax: 941-484-4076
Mailing address:
  • Phone: 941-284-4268
  • Fax: 941-484-4076

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberSW 6825
License Number StateFL

VIII. Authorized Official

Name: JUNE TOMASO-WOOD
Title or Position: PRESIDENT
Credential: LCSW
Phone: 941-284-4268