MEDICARE: MAUREEN GAMMON

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	101YM0800X	Mental Health Counselor
2	171M00000X	Case Manager/Care Coordinator

General Provider Information

NPI Number	:	1033272968
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MAUREEN GAMMON

Provider Business Mailing Address
First Line	:	759 S VAN NESS AVE
Second Line	:
City	:	SAN FRANCISCO
State	:	CA
Zip	:	94110-1908
Country	:	US
Telephone Number	:	415-642-4555
Fax Number	:	415-695-6963

Provider Business Practice Location Address
First Line	:	759 S VAN NESS AVE
Second Line	:
City	:	SAN FRANCISCO
State	:	CA
Zip	:	94110-1908
Country	:	US
Telephone Number	:	415-642-4555
Fax Number	:	415-695-6963

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

Provider Enumeration Date	:	12/19/2006
Last Update Date	:	05/12/2023

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Directions to “ MAUREEN GAMMON ” Practice Location

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