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General NPI Number Information
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NPI Number | 1619406964
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Entity Type | Individual
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Provider Name | GITI L. MAYTON LISW
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Gender | Female
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Dates
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Enumeration Date | 06/09/2017
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Last Update Date | 08/20/2018
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Provider Practice Location Address
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Address Line | 4384 CLEVELAND AVE
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City | COLUMBUS
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State | OH
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Zip | 43224
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Country | US
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Telephone | 614-556-4616
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Fax | 614-794-5155
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Provider Business Mailing Address
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Address Line | 3968 BROWN PARK DR STE C
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City | HILLIARD
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State | OH
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Zip | 43026-1165
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Country | US
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Telephone | 614-928-3663
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Fax | 614-928-3664
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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 | 104100000X
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Taxonomy Name | Social Worker
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License Number | I1700227
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License Number State | OH
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number |
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License Number State |
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