=====================================================
General NPI Number Information
=====================================================
NPI Number | 1235784703
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | REBECCA LEE GALDO
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/01/2019
-----------------------------------------------------
Last Update Date | 01/08/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 30 N RING AVE STE 400
-----------------------------------------------------
City | TARPON SPRINGS
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 34689-4365
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 856-296-6827
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3352 EISENHOWER DR
-----------------------------------------------------
City | HOLIDAY
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 34691-3317
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 727-888-3200
-----------------------------------------------------
Fax | 727-888-3201
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number | SW16463
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------