Healthcare Provider Details

I. General information

NPI: 1487388302
Provider Name (Legal Business Name): EMILY GEBHART LCSW-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/15/2022
Last Update Date: 07/15/2022
Certification Date: 07/15/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

686 PENNSYLVANIA AVE
HAGERSTOWN MD
21740-3770
US

IV. Provider business mailing address

500 CHAPEL CT APT 324
WALKERSVILLE MD
21793-8158
US

V. Phone/Fax

Practice location:
  • Phone: 240-469-4360
  • Fax:
Mailing address:
  • Phone: 443-340-7395
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number22237
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: