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NPI Code Detail

MEDICARE: MR. JOHN ROBERT GAVINO LCSW, MSW

MEDICARE: MR. JOHN ROBERT GAVINO LCSW, MSW
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
11041C0700XClinical Social Worker5479OK

General Provider Information

NPI Number : 1841523701
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. JOHN ROBERT GAVINO LCSW, MSW
Provider Business Mailing Address
First Line : 5310 E 31ST ST STE 800
Second Line :
City : TULSA
State : OK
Zip : 74135-5012
Country : US
Telephone Number : 918-600-3100
Fax Number : 918-560-1399
Provider Business Practice Location Address
First Line : 5310 E 31ST ST STE 600
Second Line :
City : TULSA
State : OK
Zip : 74135-5012
Country : US
Telephone Number : 918-600-3100
Fax Number : 918-560-1399
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/10/2009
Last Update Date : 12/13/2023

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