MEDICARE: PATRICIA LEE GILCHRIST 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	SW4404	FL

General Provider Information

NPI Number	:	1922085109
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PATRICIA LEE GILCHRIST LCSW

Provider Business Mailing Address
First Line	:	13294 COMMONWEALTH AVE
Second Line	:
City	:	PORT CHARLOTTE
State	:	FL
Zip	:	33981-4301
Country	:	US
Telephone Number	:	941-276-5096
Fax Number	:	941-698-1045

Provider Business Practice Location Address
First Line	:	13294 COMMONWEALTH AVE
Second Line	:
City	:	PORT CHARLOTTE
State	:	FL
Zip	:	33981-4301
Country	:	US
Telephone Number	:	941-276-5096
Fax Number	:	941-698-1045

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

Provider Enumeration Date	:	12/28/2005
Last Update Date	:	07/09/2007

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