MEDICARE: DR. MARIA DOLORES GANDELL PH.D., A.C.S.W.

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	104100000X	Social Worker	SW3298	FL
2	1041C0700X	Clinical Social Worker	SW3298	FL

General Provider Information

NPI Number	:	1144488313
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MARIA DOLORES GANDELL PH.D., A.C.S.W.

Provider Business Mailing Address
First Line	:	PO BOX 271384
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33688-1384
Country	:	US
Telephone Number	:	813-282-3618
Fax Number	:	813-289-6906

Provider Business Practice Location Address
First Line	:	4406 MELTON AVE
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33614-7218
Country	:	US
Telephone Number	:	407-873-0759
Fax Number	:	813-289-6906

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

Provider Enumeration Date	:	05/23/2008
Last Update Date	:	09/24/2008

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