=====================================================
General NPI Number Information
=====================================================
NPI Number | 1992865208
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | GAIL ZUSSMAN MSW, LCSWR
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/11/2006
-----------------------------------------------------
Last Update Date | 07/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 41 BRADLEY ST
-----------------------------------------------------
City | TRUMANSBURG
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 14886-9178
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 607-387-5925
-----------------------------------------------------
Fax | 607-387-9672
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 41 BRADLEY ST
-----------------------------------------------------
City | TRUMANSBURG
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 14886-9178
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 607-387-5925
-----------------------------------------------------
Fax | 607-387-9672
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number | R031297-1
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------