| N/a | |
|
25 Main St Sparta NJ 07871-1937 | |
| (862) 268-3101 | |
| Not Available |
| Full Name | N/a |
|---|---|
| Speciality | Social Worker |
| Location | 25 Main St, Sparta, New Jersey |
| Authorized Official Name and Position | Gia Leo (OWNER) |
| Authorized Official Contact | 8622683101 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| N/a 25 Main St Sparta NJ 07871-1937 Ph: (862) 268-3101 | N/a 25 Main St Sparta NJ 07871-1937 Ph: (862) 268-3101 |
| NPI Number | 1295249878 |
|---|---|
| Provider Enumeration Date | 11/19/2017 |
| Last Update Date | 08/14/2020 |
| Certification Date | 08/14/2020 |
| Medicare PECOS PAC ID | 0941533202 |
|---|---|
| Medicare Enrollment ID | O20190531001907 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1295249878 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | 44SC05542900 (New Jersey) | Primary |
| Provider Name | Gia N Leo |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1245658897 PECOS PAC ID: 3375853021 Enrollment ID: I20151109000946 |
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