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NPI Code Detail

MEDICARE: ELLEN GURNEY LCSW

MEDICARE: ELLEN GURNEY LCSW
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 WorkerLC6479ME

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1040619OTHERMEANTHEM BC/BS
22187425OTHERMECIGNA

General Provider Information

NPI Number : 1033196340
Entity Type Code : Individual
Provider Name (Legal Business Name) : ELLEN GURNEY LCSW
Provider Business Mailing Address
First Line : 12 FULLER ST
Second Line :
City : PORTLAND
State : ME
Zip : 04103-1710
Country : US
Telephone Number : 207-329-4024
Fax Number : 207-761-4001
Provider Business Practice Location Address
First Line : 9 HASTINGS ST
Second Line :
City : PORTLAND
State : ME
Zip : 04102-2015
Country : US
Telephone Number : 207-329-4024
Fax Number : 207-761-4001
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/28/2005
Last Update Date : 07/08/2007

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