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NPI Code Detail

MEDICARE: TIA BALTHROP RCSWI

MEDICARE: TIA BALTHROP RCSWI
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 WorkerISW17696FL

General Provider Information

NPI Number : 1962111880
Entity Type Code : Individual
Provider Name (Legal Business Name) : TIA BALTHROP RCSWI
Provider Business Mailing Address
First Line : 1951 N MERIDIAN RD APT 66
Second Line :
City : TALLAHASSEE
State : FL
Zip : 32303-5237
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 13305 MAHAN DR
Second Line :
City : TALLAHASSEE
State : FL
Zip : 32309-8698
Country : US
Telephone Number : 850-893-8800
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/18/2022
Last Update Date : 11/18/2022

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Directions to “ TIA BALTHROP RCSWI” Practice Location

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