MEDICARE: CHILD ABUSE COUNCIL

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251B00000X	Case Management Agency

General Provider Information

NPI Number	:	1053646422
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CHILD ABUSE COUNCIL

Provider Business Mailing Address
First Line	:	3108 W AZEELE ST
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33609-3059
Country	:	US
Telephone Number	:	813-673-4646
Fax Number	:	813-673-4644

Provider Business Practice Location Address
First Line	:	3108 W AZEELE ST
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33609-3059
Country	:	US
Telephone Number	:	813-673-4646
Fax Number	:	813-673-4644

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR
Name	:	MR. PAUL D'AGOSTINO
Credential	:
Telephone Number	:	813-673-4646

Provider Enumeration Date	:	10/02/2009
Last Update Date	:	10/02/2009

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