MEDICARE: PARKSIDE CONSULTING INC

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	54	SC

General Provider Information

NPI Number	:	1649492828
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PARKSIDE CONSULTING INC

Provider Business Mailing Address
First Line	:	800 E WASHINGTON ST
Second Line	:
City	:	GREENVILLE
State	:	SC
Zip	:	29601-3054
Country	:	US
Telephone Number	:	864-271-1515
Fax Number	:	864-271-1016

Provider Business Practice Location Address
First Line	:	800 E WASHINGTON ST
Second Line	:
City	:	GREENVILLE
State	:	SC
Zip	:	29601-3054
Country	:	US
Telephone Number	:	864-271-1515
Fax Number	:	864-271-1016

Authorized Official
Title or Position	:	OWNER
Name	:	MS. GAIL NAGEL
Credential	:	LISW-CP
Telephone Number	:	864-271-1515

Provider Enumeration Date	:	05/03/2007
Last Update Date	:	08/22/2020

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