MEDICARE: BETH GULINO

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	1041C0700X	Clinical Social Worker	34006829A	IN

General Provider Information

NPI Number	:	1184049090
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BETH GULINO

Provider Business Mailing Address
First Line	:	2423 FAIRFIELD AVE
Second Line	:
City	:	FORT WAYNE
State	:	IN
Zip	:	46807-1210
Country	:	US
Telephone Number	:	260-438-4029
Fax Number	:	260-745-9431

Provider Business Practice Location Address
First Line	:	2423 FAIRFIELD AVE
Second Line	:
City	:	FORT WAYNE
State	:	IN
Zip	:	46807-1210
Country	:	US
Telephone Number	:	260-438-4029
Fax Number	:	260-745-0734

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/28/2014
Last Update Date	:	02/28/2014

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Directions to “ BETH GULINO ” Practice Location

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