MEDICARE: GAIL BIALK LCSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	171M00000X	Case Manager/Care Coordinator	127934-121	WI
2	1041C0700X	Clinical Social Worker	SW13749	FL

General Provider Information

NPI Number	:	1003145384
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GAIL BIALK LCSW

Provider Business Mailing Address
First Line	:	12791 WORLD PLAZA LN BLDG 89
Second Line	:
City	:	FORT MYERS
State	:	FL
Zip	:	33907-3989
Country	:	US
Telephone Number	:	239-829-5494
Fax Number	:	239-645-4777

Provider Business Practice Location Address
First Line	:	12791 WORLD PLAZA LN BLDG 89
Second Line	:
City	:	FORT MYERS
State	:	FL
Zip	:	33907-3989
Country	:	US
Telephone Number	:	239-829-5494
Fax Number	:	239-645-4777

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/15/2009
Last Update Date	:	05/06/2021

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Directions to “ GAIL BIALK LCSW” Practice Location

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