MEDICARE: PAMELA H GORSKI BCBA

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	103K00000X	Behavior Analyst	1-04-1806

General Provider Information

NPI Number	:	1841520749
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PAMELA H GORSKI BCBA

Provider Business Mailing Address
First Line	:	1602 WILLIAM ST
Second Line	:	UPPER FLOOR
City	:	FREDERICKSBURG
State	:	VA
Zip	:	22401-5549
Country	:	US
Telephone Number	:	540-368-8087
Fax Number	:	540-368-8059

Provider Business Practice Location Address
First Line	:	1602 WILLIAM ST
Second Line	:	UPPER FLOOR
City	:	FREDERICKSBURG
State	:	VA
Zip	:	22401-5549
Country	:	US
Telephone Number	:	540-368-8087
Fax Number	:	540-368-8059

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

Provider Enumeration Date	:	12/28/2009
Last Update Date	:	12/28/2009

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