Healthcare Provider Details

I. General information

NPI: 1679892186
Provider Name (Legal Business Name): DANIEL GUMMO B.A.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/24/2010
Last Update Date: 05/24/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1100 S CAMERON ST
HARRISBURG PA
17104-2547
US

IV. Provider business mailing address

208B E BURD ST
SHIPPENSBURG PA
17257-1402
US

V. Phone/Fax

Practice location:
  • Phone: 717-238-7662
  • Fax: 717-238-7894
Mailing address:
  • Phone: 717-439-6620
  • Fax:

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: