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General NPI Number Information
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NPI Number | 1427487032
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Entity Type | Individual
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Provider Name | MARY MEADERS GERBER LCSW
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Gender | Female
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Dates
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Enumeration Date | 11/04/2013
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Last Update Date | 12/16/2013
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Provider Practice Location Address
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Address Line | 50 LEANNI WAY SUITE B3
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City | PALM COAST
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State | FL
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Zip | 32137-4751
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Country | US
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Telephone | 386-446-5494
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Fax |
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Provider Business Mailing Address
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Address Line | 407 ALDO DR
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City | BUNNELL
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State | FL
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Zip | 32110-4995
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Country | US
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Telephone | 386-503-1779
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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 | SW11412
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License Number State | FL
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