MEDICARE: GAYLE M CRUTCHFIELD L.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	1041C0700X	Clinical Social Worker	0904001772	VA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1225110182
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GAYLE M CRUTCHFIELD L.C.S.W.

Provider Business Mailing Address
First Line	:	1891 BILLINGSGATE CIR STE D
Second Line	:
City	:	RICHMOND
State	:	VA
Zip	:	23238-4242
Country	:	US
Telephone Number	:	804-750-2105
Fax Number	:	804-750-2179

Provider Business Practice Location Address
First Line	:	1891 BILLINGSGATE CIR STE D
Second Line	:
City	:	RICHMOND
State	:	VA
Zip	:	23238-4242
Country	:	US
Telephone Number	:	804-750-2105
Fax Number	:	804-750-2179

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

Provider Enumeration Date	:	10/20/2006
Last Update Date	:	07/08/2007

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