Healthcare Provider Details

I. General information

NPI: 1417078312
Provider Name (Legal Business Name): GAIL GREENHUT LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/02/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1031 NW 6TH ST STE C2
GAINESVILLE FL
32601-4277
US

IV. Provider business mailing address

1031 NW 6TH ST STE C2
GAINESVILLE FL
32601-4277
US

V. Phone/Fax

Practice location:
  • Phone: 352-376-5543
  • Fax: 352-376-2042
Mailing address:
  • Phone: 352-376-5543
  • Fax: 352-376-2042

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberSW0566
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: