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General NPI Number Information
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NPI Number | 1477545846
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Entity Type | Individual
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Provider Name | EILEEN GUSTAFSON LCSW
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Gender | Female
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Dates
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Enumeration Date | 08/22/2005
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Last Update Date | 07/03/2008
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Provider Practice Location Address
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Address Line | 10335 CROSS CREEK BLVD SUITE 23
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City | TAMPA
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State | FL
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Zip | 33647-2795
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Country | US
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Telephone | 352-428-8463
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Fax | 352-597-2074
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Provider Business Mailing Address
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Address Line | PO BOX 5797
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City | SPRING HILL
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State | FL
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Zip | 34611-5797
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Country | US
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Telephone | 352-428-8463
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Fax | 352-597-2074
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 6283
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License Number State | FL
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