Healthcare Provider Details

I. General information

NPI: 1073068276
Provider Name (Legal Business Name): GAYLE C HINEBAUGH LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/18/2016
Last Update Date: 05/30/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

520 HUGART ST
CONFLUENCE PA
15424-1018
US

IV. Provider business mailing address

119 AUGUSTINE RD
SOMERSET PA
15501-5438
US

V. Phone/Fax

Practice location:
  • Phone: 814-714-0001
  • Fax: 814-217-1766
Mailing address:
  • Phone: 814-442-2150
  • Fax: 814-217-1766

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberCW017877
License Number StatePA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: