MEDICARE: MS. CAMILE S GAYLE 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	374J00000X	Doula	CD (DONA)	FL
2	1041C0700X	Clinical Social Worker	079651-1	NY
3	1041C0700X	Clinical Social Worker	SW11284	FL

General Provider Information

NPI Number	:	1063739191
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. CAMILE S GAYLE LCSW

Provider Business Mailing Address
First Line	:	22053 PALMS WAY
Second Line	:	APT #202
City	:	BOCA RATON
State	:	FL
Zip	:	33433-8091
Country	:	US
Telephone Number	:	917-573-5411
Fax Number	:

Provider Business Practice Location Address
First Line	:	900 NE 18TH AVE
Second Line	:	1207
City	:	FT LAUDERDALE
State	:	FL
Zip	:	33304-3063
Country	:	US
Telephone Number	:	917-573-5411
Fax Number	:

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

Provider Enumeration Date	:	04/29/2010
Last Update Date	:	05/16/2015

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