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General NPI Number Information
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NPI Number | 1003095936
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Entity Type | Individual
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Provider Name | EVAN E GAMSU LCSW
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Gender | Male
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Dates
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Enumeration Date | 10/27/2007
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Last Update Date | 10/27/2007
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Provider Practice Location Address
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Address Line | 600 W MECHANIC AVE
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City | INDEPENDENCE
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State | MO
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Zip | 64050-1769
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Country | US
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Telephone | 913-269-0577
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Fax |
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Provider Business Mailing Address
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Address Line | 4515 W 78TH TER
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City | PRAIRIE VILLAGE
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State | KS
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Zip | 66208-4363
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Country | US
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Telephone | 913-269-0577
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 005218
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License Number State | MO
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