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General NPI Number Information
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NPI Number | 1730427972
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Entity Type | Organization
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Legal Business Name | WAYNE M. GURNICK MS, LCSW P.C.
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Dates
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Enumeration Date | 01/23/2013
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Last Update Date | 01/23/2013
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Provider Practice Location Address
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Address Line | 111 MAIN ST
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City | CENTER MORICHES
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State | NY
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Zip | 11934-1709
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Country | US
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Telephone | 631-603-7902
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Fax |
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Provider Business Mailing Address
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Address Line | 2 ELLEN LN
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City | MANORVILLE
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State | NY
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Zip | 11949-3222
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Country | US
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Telephone | 631-878-2109
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Fax |
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Authorized Official
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Title or Position | LICENSED CLINICAL SOCIAL WORKER
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Name | MR. WAYNE MICHAEL GURNICK
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Credential | MS, LCSW
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Telephone | 631-603-7902
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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 | R050891
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License Number State | NY
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