Provider Demographics
NPI:1295775120
Name:EATON, GINA V (LCSW)
Entity type:Individual
Prefix:
First Name:GINA
Middle Name:V
Last Name:EATON
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5400 S UNIVERSITY DRIVE
Mailing Address - Street 2:SUITE #207
Mailing Address - City:DAVIE
Mailing Address - State:FL
Mailing Address - Zip Code:33328
Mailing Address - Country:US
Mailing Address - Phone:954-370-3335
Mailing Address - Fax:954-370-3353
Practice Address - Street 1:5400 S UNIVERSITY DRIVE
Practice Address - Street 2:SUITE #207
Practice Address - City:DAVIE
Practice Address - State:FL
Practice Address - Zip Code:33328
Practice Address - Country:US
Practice Address - Phone:954-370-3335
Practice Address - Fax:954-370-3353
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW3884104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker