MEDICARE: GAIL MARIE PURVIS 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
1	1041C0700X	Clinical Social Worker	044405	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1578669818
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GAIL MARIE PURVIS LCSW

Provider Business Mailing Address
First Line	:	3083 CRESCENT ST APT 5E
Second Line	:
City	:	ASTORIA
State	:	NY
Zip	:	11102-2700
Country	:	US
Telephone Number	:	212-946-1583
Fax Number	:	212-666-0642

Provider Business Practice Location Address
First Line	:	466 LEXINGTON AVE
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10017-3140
Country	:	US
Telephone Number	:	212-946-1583
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/15/2006
Last Update Date	:	09/30/2023

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