Healthcare Provider Details

I. General information

NPI: 1356710321
Provider Name (Legal Business Name): MICHAEL GATHERS B.S.W
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/21/2015
Last Update Date: 09/21/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

60 PALMERS HILL RD
STAMFORD CT
06902-2113
US

IV. Provider business mailing address

335 GLENBROOK RD FL 2
STAMFORD CT
06906-2119
US

V. Phone/Fax

Practice location:
  • Phone: 203-629-2822
  • Fax:
Mailing address:
  • Phone: 203-909-5731
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: