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NPI Code Detail

MEDICARE: GINA L TITONE LCSW

MEDICARE: GINA L TITONE 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
11041C0700XClinical Social Worker2011039258MO

General Provider Information

NPI Number : 1871869891
Entity Type Code : Individual
Provider Name (Legal Business Name) : GINA L TITONE LCSW
Provider Business Mailing Address
First Line : 900 E. LA HARPE ST
Second Line :
City : KIRKSVILLE
State : MO
Zip : 63501-4520
Country : US
Telephone Number : 660-665-1962
Fax Number : 660-665-3989
Provider Business Practice Location Address
First Line : 11701 W FLORISSANT AVE
Second Line :
City : FLORISSANT
State : MO
Zip : 63033-6744
Country : US
Telephone Number : 314-584-1010
Fax Number : 314-584-1008
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/23/2012
Last Update Date : 05/20/2014

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