Healthcare Provider Details

I. General information

NPI: 1285740977
Provider Name (Legal Business Name): ELLEN R GACHE LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/22/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1890 N UNIVERSITY DR SUITE 215
CORAL SPRINGS FL
33071-8963
US

IV. Provider business mailing address

1890 N UNIVERSITY DR SUITE 215
CORAL SPRINGS FL
33071-8963
US

V. Phone/Fax

Practice location:
  • Phone: 954-227-2700
  • Fax:
Mailing address:
  • Phone: 954-227-2700
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberSW001896
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: