MEDICARE: GINA VALENTINE INC

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	SW5897	FL

General Provider Information

NPI Number	:	1366746919
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GINA VALENTINE INC

Provider Business Mailing Address
First Line	:	435 S RIDGEWOOD AVE
Second Line	:	SUITE 109
City	:	DAYTONA BEACH
State	:	FL
Zip	:	32114-4927
Country	:	US
Telephone Number	:	386-252-4110
Fax Number	:	386-257-3354

Provider Business Practice Location Address
First Line	:	435 S RIDGEWOOD AVE
Second Line	:	SUITE 109
City	:	DAYTONA BEACH
State	:	FL
Zip	:	32114-4927
Country	:	US
Telephone Number	:	386-252-4110
Fax Number	:	386-257-3354

Authorized Official
Title or Position	:	PRESIDENT
Name	:	GINA VALENTINE
Credential	:	L.C.S.W.
Telephone Number	:	386-252-4110

Provider Enumeration Date	:	12/22/2010
Last Update Date	:	12/22/2010

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Directions to “GINA VALENTINE INC ” Practice Location

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