MEDICARE: GAIL D GUILLORY 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	1041C0700X	Clinical Social Worker	4347	FL
2	1041C0700X	Clinical Social Worker	SW4347	FL

General Provider Information

NPI Number	:	1336122464
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GAIL D GUILLORY LCSW

Provider Business Mailing Address
First Line	:	4310 METRO PKWY STE 205
Second Line	:
City	:	FORT MYERS
State	:	FL
Zip	:	33916-9416
Country	:	US
Telephone Number	:	239-223-2751
Fax Number	:	239-561-2933

Provider Business Practice Location Address
First Line	:	4425 MILITARY TRL STE 203
Second Line	:
City	:	JUPITER
State	:	FL
Zip	:	33458-4817
Country	:	US
Telephone Number	:	561-747-2775
Fax Number	:	561-747-1881

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

Provider Enumeration Date	:	11/22/2005
Last Update Date	:	09/01/2022

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Directions to “ GAIL D GUILLORY LCSW” Practice Location

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