MEDICARE: GITI L. MAYTON LISW

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	104100000X	Social Worker	I1700227	OH
2	1041C0700X	Clinical Social Worker

General Provider Information

NPI Number	:	1619406964
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GITI L. MAYTON LISW

Provider Business Mailing Address
First Line	:	3968 BROWN PARK DR STE C
Second Line	:
City	:	HILLIARD
State	:	OH
Zip	:	43026-1165
Country	:	US
Telephone Number	:	614-928-3663
Fax Number	:	614-928-3664

Provider Business Practice Location Address
First Line	:	4384 CLEVELAND AVE
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43224
Country	:	US
Telephone Number	:	614-556-4616
Fax Number	:	614-794-5155

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

Provider Enumeration Date	:	06/09/2017
Last Update Date	:	08/20/2018

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