=====================================================
General NPI Number Information
=====================================================
NPI Number | 1124189477
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | GAIL R. FIORE MA, LCSW, BCD, CEAP
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/12/2006
-----------------------------------------------------
Last Update Date | 07/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4559 OLD WILLIAM PENN HWY SUITE100
-----------------------------------------------------
City | MURRYSVILLE
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 15668-1950
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 724-733-7344
-----------------------------------------------------
Fax | 724-327-3188
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4559 OLD WILLIAM PENN HWY SUITE100
-----------------------------------------------------
City | MURRYSVILLE
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 15668-1950
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 724-733-7344
-----------------------------------------------------
Fax | 724-327-3188
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YM0800X
-----------------------------------------------------
Taxonomy Name | Mental Health Counselor
-----------------------------------------------------
License Number | CW012466
-----------------------------------------------------
License Number State | PA
-----------------------------------------------------