=====================================================
General NPI Number Information
=====================================================
NPI Number | 1356589923
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | JUNE TOMASO-WOOD LCSW LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/04/2009
-----------------------------------------------------
Last Update Date | 02/04/2009
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 269 VENICE PALMS BLVD
-----------------------------------------------------
City | VENICE
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 34292-2449
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 941-284-4268
-----------------------------------------------------
Fax | 941-484-4076
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 269 VENICE PALMS BLVD
-----------------------------------------------------
City | VENICE
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 34292-2449
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 941-284-4268
-----------------------------------------------------
Fax | 941-484-4076
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | JUNE TOMASO-WOOD
-----------------------------------------------------
Credential | LCSW
-----------------------------------------------------
Telephone | 941-284-4268
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number | SW 6825
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------