MEDICARE: LISA GAUGER LULOFS 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	SW 7986	FL

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	:	1336298207
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LISA GAUGER LULOFS LCSW

Provider Business Mailing Address
First Line	:	975 PARKVIEW DR
Second Line	:
City	:	TALLAHASSEE
State	:	FL
Zip	:	32311-1245
Country	:	US
Telephone Number	:	850-402-0606
Fax Number	:	850-942-8664

Provider Business Practice Location Address
First Line	:	2390 PHILLIPS RD
Second Line	:
City	:	TALLAHASSEE
State	:	FL
Zip	:	32308-5326
Country	:	US
Telephone Number	:	850-402-0606
Fax Number	:	850-942-8664

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

Provider Enumeration Date	:	01/09/2007
Last Update Date	:	07/08/2007

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