MEDICARE: ANDREW SCOTT GELBURD

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	1041C0700X	Clinical Social Worker	259511	KY

General Provider Information

NPI Number	:	1104640432
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANDREW SCOTT GELBURD

Provider Business Mailing Address
First Line	:	962 SAMUEL ST
Second Line	:
City	:	LOUISVILLE
State	:	KY
Zip	:	40204-2459
Country	:	US
Telephone Number	:	717-571-2487
Fax Number	:

Provider Business Practice Location Address
First Line	:	962 SAMUEL ST
Second Line	:
City	:	LOUISVILLE
State	:	KY
Zip	:	40204-2459
Country	:	US
Telephone Number	:	717-571-2487
Fax Number	:

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

Provider Enumeration Date	:	11/13/2024
Last Update Date	:	11/15/2024

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