MEDICARE: ASHLEY GAMBINO MA, LPC, LCADC

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	101YA0400X	Addiction (Substance Use Disorder) Counselor
2	101YP2500X	Professional Counselor

General Provider Information

NPI Number	:	1164799128
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ASHLEY GAMBINO MA, LPC, LCADC

Provider Business Mailing Address
First Line	:	981 RTE 22
Second Line	:
City	:	BRIDGEWATER
State	:	NJ
Zip	:	08807-2946
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	981 RTE 22
Second Line	:
City	:	BRIDGEWATER
State	:	NJ
Zip	:	08807-2946
Country	:	US
Telephone Number	:	908-231-0511
Fax Number	:

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

Provider Enumeration Date	:	11/18/2011
Last Update Date	:	08/12/2013

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