Healthcare Provider Details

I. General information

NPI: 1952705857
Provider Name (Legal Business Name): ANTHONY EDWARD GARGANO LPCC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/21/2014
Last Update Date: 03/24/2020
Certification Date: 03/24/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3333 BURNET AVE # MLC3014
CINCINNATI OH
45229-3026
US

IV. Provider business mailing address

3333 BURNET AVE # MLC5021
CINCINNATI OH
45229-3026
US

V. Phone/Fax

Practice location:
  • Phone: 513-636-4788
  • Fax: 513-517-3026
Mailing address:
  • Phone: 513-636-5278
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberE.1901424
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: