Healthcare Provider Details

I. General information

NPI: 1518570167
Provider Name (Legal Business Name): LINDSAY GUMM LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/24/2020
Last Update Date: 08/24/2020
Certification Date: 08/24/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4077 FIFTH AVE
SAN DIEGO CA
92103-2105
US

IV. Provider business mailing address

4077 FIFTH AVE
SAN DIEGO CA
92103-2105
US

V. Phone/Fax

Practice location:
  • Phone: 619-294-8111
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number81347
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: