Gina Marie Defalco, LCSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

CSW004228 Issued in GA

Practice address

485 Huntington Rd
Ste 201
Athens, GA 30606-1845

Phone

(706) 546-8440

Fax

(706) 546-8456

NPI assigned

Feb 22, 2006

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1140566400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1665964800000",
    "number": "1851366736",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "485 HUNTINGTON RD",
            "address_2": "STE 201",
            "city": "ATHENS",
            "state": "GA",
            "postal_code": "306061845",
            "telephone_number": "706-546-8440",
            "fax_number": "706-546-8456"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "485 HUNTINGTON RD",
            "address_2": "STE 201",
            "city": "ATHENS",
            "state": "GA",
            "postal_code": "306061845",
            "telephone_number": "706-546-8440",
            "fax_number": "706-546-8456"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DEFALCO",
        "first_name": "GINA",
        "middle_name": "MARIE",
        "credential": "LCSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-02-22",
        "last_updated": "2022-10-17",
        "certification_date": "2022-10-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "104100000X",
            "taxonomy_group": "",
            "desc": "Social Worker",
            "state": "GA",
            "license": "MSW002441",
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "GA",
            "license": "CSW004228",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Clinical Social Worker in Athens, GA
• Providers in Athens, GA by specialty
• Clinical Social Worker in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 17, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.