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NPI Code Detail

MEDICARE: DEBORAH LYNN ACITO LCSW

MEDICARE: DEBORAH LYNN ACITO LCSW
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
1101YM0800XMental Health Counselor34000846AIN
21041C0700XClinical Social Worker34000849AIN

General Provider Information

NPI Number : 1811973381
Entity Type Code : Individual
Provider Name (Legal Business Name) : DEBORAH LYNN ACITO LCSW
Provider Business Mailing Address
First Line : 601 W 2ND ST
Second Line :
City : BLOOMINGTON
State : IN
Zip : 47403-2317
Country : US
Telephone Number : 812-353-9568
Fax Number : 812-353-9318
Provider Business Practice Location Address
First Line : 445 S LANDMARK AVE
Second Line :
City : BLOOMINGTON
State : IN
Zip : 47403-5004
Country : US
Telephone Number : 812-353-3450
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/16/2005
Last Update Date : 10/16/2014

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