Healthcare Provider Details

I. General information

NPI: 1922465079
Provider Name (Legal Business Name): GAIL MAYMON BA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/20/2016
Last Update Date: 01/20/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

817 N DIXIE HWY
POMPANO BEACH FL
33060-5621
US

IV. Provider business mailing address

2240 N CYPRESS BEND DR
POMPANO BEACH FL
33069-5617
US

V. Phone/Fax

Practice location:
  • Phone: 954-785-8285
  • Fax: 954-928-0040
Mailing address:
  • Phone: 54-785-8285
  • Fax: 954-928-0040

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: