Provider Demographics
NPI:1699278937
Name:JAMES FALDUTI LLC
Entity type:Organization
Organization Name:JAMES FALDUTI LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL SOCIAL WORKER
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:
Authorized Official - Last Name:FALDUTI
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:518-650-5771
Mailing Address - Street 1:1954 PALACO GRANDE PKWY
Mailing Address - Street 2:
Mailing Address - City:CAPE CORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33904-4448
Mailing Address - Country:US
Mailing Address - Phone:518-622-4081
Mailing Address - Fax:
Practice Address - Street 1:1314 CAPE CORAL PKWY E STE 322
Practice Address - Street 2:
Practice Address - City:CAPE CORAL
Practice Address - State:FL
Practice Address - Zip Code:33904-9695
Practice Address - Country:US
Practice Address - Phone:518-622-4081
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-03-13
Last Update Date:2018-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty