=====================================================
General NPI Number Information
=====================================================
NPI Number | 1306397765
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | LUCILLE GIACONE-KLEIN LCSW CORP
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/20/2016
-----------------------------------------------------
Last Update Date | 07/21/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1645 PALM BEACH LAKES BLVD STE 440
-----------------------------------------------------
City | WEST PALM BEACH
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33401-2217
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 561-389-2283
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 15175 93RD ST N
-----------------------------------------------------
City | WEST PALM BEACH
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33412-1798
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 561-389-2283
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | LUCILLE GIACONE-KLEIN LCSW CORP
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 561-389-2283
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number | 5991
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------