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General NPI Number Information
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NPI Number | 1295241289
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Entity Type | Organization
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Legal Business Name | MARY MEADERS GERBER, LCSW, INC.
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Dates
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Enumeration Date | 12/28/2017
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Last Update Date | 12/28/2017
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Provider Practice Location Address
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Address Line | 50 LEANNI WAY STE B-3
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City | PALM COAST
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State | FL
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Zip | 32137
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Country | US
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Telephone | 386-589-1736
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Fax |
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Provider Business Mailing Address
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Address Line | 50 LEANNI WAY STE B-3
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City | PALM COAST
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State | FL
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Zip | 32137
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Country | US
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Telephone | 386-589-1736
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Fax |
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Authorized Official
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Title or Position | DIRECTOR
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Name | MS. MARY MEADERS GERBER
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Credential | LCSW
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Telephone | 386-589-1736
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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 | SW11412
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License Number State | FL
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