MEDICARE: GINA V EATON LCSW PA

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	3884	FL

General Provider Information

NPI Number	:	1689845927
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GINA V EATON LCSW PA

Provider Business Mailing Address
First Line	:	5400 S UNIVERSITY DR
Second Line	:	SUITE #207
City	:	DAVIE
State	:	FL
Zip	:	33328-5312
Country	:	US
Telephone Number	:	954-370-3335
Fax Number	:	954-370-3353

Provider Business Practice Location Address
First Line	:	5400 S UNIVERSITY DR
Second Line	:	SUITE #207
City	:	DAVIE
State	:	FL
Zip	:	33328-5312
Country	:	US
Telephone Number	:	954-370-3335
Fax Number	:	954-370-3353

Authorized Official
Title or Position	:	PRESIDENT
Name	:	GINA V EATON
Credential	:	LCSW
Telephone Number	:	954-370-3335

Provider Enumeration Date	:	03/14/2008
Last Update Date	:	03/14/2008

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